title: Comparisons of stuttering frequency during and after speech initiation in unaltered feedback, altered auditory feedback and choral speech conditions.
abstract: BACKGROUND
  Stuttering is prone to strike during speech initiation more so than at any other point in an utterance. The use of auditory feedback (AAF) has been found to produce robust decreases in the stuttering frequency by creating an electronic rendition of choral speech (i.e., speaking in unison). However, AAF requires users to self-initiate speech before it can go into effect and, therefore, it might not be as helpful as true choral speech during speech initiation.
  
  
  OBJECTIVE
  To examine how AAF and choral speech differentially enhance fluency during speech initiation and in subsequent portions of utterances.
  
  
  METHODS
  Ten participants who stuttered read passages without altered feedback (NAF), under four AAF conditions and under a true choral speech condition. Each condition was blocked into ten 10 s trials separated by 5 s intervals so each trial required 'cold' speech initiation. In the first analysis, comparisons of stuttering frequencies were made across conditions. A second, finer grain analysis involved examining stuttering frequencies on the initial syllable, the subsequent four syllables produced and the five syllables produced immediately after the midpoint of each trial.
  
  
  RESULTS
  On average, AAF reduced stuttering by approximately 68% relative to the NAF condition. Stuttering frequencies on the initial syllables were considerably higher than on the other syllables analysed (0.45 and 0.34 for NAF and AAF conditions, respectively). After the first syllable was produced, stuttering frequencies dropped precipitously and remained stable. However, this drop in stuttering frequency was significantly greater (approximately 84%) in the AAF conditions than in the NAF condition (approximately 66%) with frequencies on the last nine syllables analysed averaging 0.15 and 0.05 for NAF and AAF conditions, respectively. In the true choral speech condition, stuttering was virtually (approximately 98%) eliminated across all utterances and all syllable positions.
  
  
  CONCLUSIONS
  Altered auditory feedback effectively inhibits stuttering immediately after speech has been initiated. However, unlike a true choral signal, which is exogenously initiated and offers the most complete fluency enhancement, AAF requires speech to be initiated by the user and 'fed back' before it can directly inhibit stuttering. It is suggested that AAF can be a viable clinical option for those who stutter and should often be used in combination with therapeutic techniques, particularly those that aid speech initiation. The substantially higher rate of stuttering occurring on initiation supports a hypothesis that overt stuttering events help 'release' and 'inhibit' central stuttering blocks. This perspective is examined in the context of internal models and mirror neurons.
authors.affiliation: Audiology and Speech Pathology, University of Tennessee, Knoxville, TN 37996, USA. tsaltukl@utk.edu
authors.forename: Tim
authors.initials: T
authors.lastname: Saltuklaroglu
authors.forename: Joseph
authors.initials: J
authors.lastname: Kalinowski
authors.forename: Mary
authors.initials: M
authors.lastname: Robbins
authors.forename: Stephen
authors.initials: S
authors.lastname: Crawcour
authors.forename: Andrew
authors.initials: A
authors.lastname: Bowers
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods; D000293:Adolescent; D000328:Adult; D001307:Auditory Perception; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010700:Phonetics; D011578:Psycholinguistics; D011932:Reading; D013060:Speech; D013342:Stuttering / Q000523:psychology*; D013647:Task Performance and Analysis; D013997:Time Factors; D055815:Young Adult