More discussion on research of the SpeechEasy device

photo: Janus Development Group

An interesting discussion is taking place in the comments of our May 2009 post "A great research article on the SpeechEasy." We'd like to bring this exchange to the forefront rather than have it remain virtually buried in last May's archives. The post featured a short video of Chamonix introducing a research article by then-AIS intern, now PhD (congratulations!), Ryan Pollard on the SpeechEasy, an altered auditory feedback device that was developed to reduce stuttering.Dr. Joseph Kalinowski, a professor at East Carolina University and co-inventor of the SpeechEasy, commented earlier this month on that post. Here is his comment:

I “graduated” from CRC – the center Cathy ran in 1981 and that was a life changing experience. Her work, dedication and all she does for those who stutter are remarkable gifts to all of us who stutter. I personally will never be able to repay her for her efforts in my life but my colleagues and I have, in some small way paid it forward to others who stutter. Our work with the Speech Easy and altered auditory feedback (AAF) is more of a tribute than a challenge to all those who work so hard in the behavioral/cognitive modality. My colleagues and I suggest that stuttering therapy should consist of anything that helps that individual who stutters. That may be behavioral/cognitive therapy alone, altered auditory feedback devices, AAF and behavioral/cognitive strategies together or no therapy at all. The client should make choices based on what works for them. We respect consumer choice!We recently had a replied to Pollard article in JSHLR, that reply pointed out a number of methodological and interpretive concerns on our part. This reply should appear in JSHLR in the next few issues, the authors of the study will reply in kind. We will let the readership of that journal decide for them what was really found in that study.We know a few things for certain:1. Altered auditory feedback is a powerful stuttering inhibitor (choral speech, shadow speech, delayed auditory feedback (DAF), frequency altered feedback (FAF), reverberation, etc.2. The Speech Easy generates a form of AAF that is helpful to many people who stutter, and although the Pollard study showed a lack overt improvement, most of the users in that study were pleased with the SpeechEasy. Some purchased the SpeechEasy, while others said it was something that would use if it were provided for free (e.g., insurance, vocational rehabilitation). That is very strange….. All other peer-reviewed journal publications on the Speech Easy revealed significant, long-lasting improvements. With this in mind, more research will reveal the true nature of AAF in stuttering therapy.We are all working for the betterment of those who stutter. It may appear that we are on different roads but that is illusionary, we all want the day to come when oral communication by a person who stutters is free of overt an covert symptoms (e,g avoidances, substitutions, circumlocutions), is natural sounding, and effortless. No therapy modality (drugs, behavioral/cognitive therapy, AAF) perfectly achieves that goal as of today. We all continue our quest and hope others see our vigorous debates as a sign of a vibrant, intellectual community that is in pursuit off the best answers. The road is long, and some of the travelers are tired and getting old, but we know that others will continue the quest for unbridled fluency and one day that dream will come true.I wish you, Cathy and all those at the center the best of luck and am grateful for all you do.

We thank Dr. Kalinowski for taking part in the discussion. Here is what Chamonix has written in response:

Hi Joe - Thanks so much for your comment. 1981 – that’s quite a history with Catherine (Cathy to you!). This place and the therapy have changed a LOT since then, but so has the field and the information we have, so it should change.I have done hundreds of consultations, and many of the clients have tried the SpeechEasy device and were unhappy with the results. But I’ve also read research articles that show some clients who continue to successfully use it.When a new client asks me, “What about these things that you stick in your ear?” I share with them what many clients have shared with me, articles that I am familiar with that have been published, and updates at conferences that I attend. I refer them to an SLP who distributes the device here in NYC if they want to try it for themselves. I never tell a client what will work for them or what they should do. I am only supplying information.One of the issues that I feel made the SpeechEasy controversial in our field was when it began to be touted as a cure for stuttering. Oprah had a show on “medical miracles,” and the SpeechEasy was shown. It’s not so easy as “stick this in your ear and you’ll never stutter again,” but somehow that is how things came across years ago. I think the controversy is dying down now that AAF devices are recommended as a tool that can help some people and are recommended with speech therapy for best results.My belief is that each person who stutters is different and has a different neurological, psychological, and genetic make-up. Something is going on in the brain that causes stuttering to occur, which researchers are still trying to determine where and how. There is no one cure-all for stuttering (at least not on February 19, 2010) and people can benefit from many things or a combination of things, like cognitive therapy, physical speech techniques, AAF devices, and possibly even Pagoclone. The client needs to decide what is best for them, and we get the privilege of working with them to expose them to various things that could really be helpful and life-changing.

And finally, Dr. Ryan Pollard also responded to Dr. Kalinowski's comment. Here is his reply:

Kalinowski and colleagues’ letter to the editor and our response to their “methodological and interpretive concerns” will be published in a forthcoming issue of the Journal of Speech, Language and Hearing Research. We encourage the interested reader to look for it.Until then, I might point out an important error in Mr. Kalinowski’s post. He inaccurately states that, “all other peer-reviewed journal publications on the SpeechEasy revealed significant, long-lasting improvements.” In truth, two studies have reported longitudinal evidence of positive group effects. One study examined eight subjects in the laboratory after 4 months and 12 months of wearing the device (Stuart et al., 2004, 2006). Another study collected surveys from people who had already liked the SpeechEasy enough to purchase it (Kalinowski et al., 2004). Both were conducted by the developers of the SpeechEasy.However, there are also two longitudinal experiments that were conducted in naturalistic settings (i.e., outside the laboratory) (O’Donnell et al., 2008; Pollard et al., 2009). The results from both of these studies suggest that the SpeechEasy is beneficial for some but not for others, and, importantly, the effects of the device may wear off over time for many users. There’s a term in research called “external validity,” which refers to how easily the findings of a study can be generalized to a larger population in the real world. Both our study and the O’Donnell et al. paper had relatively strong external validity because we examined subjects’ speech in the types of places where people who stutter actually live their lives.

Thanks again to Dr. Kalinowski and Ryan for offering their input. That's a lot of point/counterpoint for you, the reader, to digest, but it's important and relevant debate as new research continues to break ground in the field of stuttering. Let's continue the discussion.Have you used or do you use the SpeechEasy device? We would appreciate your thoughts and reviews.