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Reduced hemispheric asymmetries, as well as their behavioral manifestation in the form of atypical handedness (i.e., non-right, left-, or mixed-handedness), are linked to neurodevelopmental disorders, such as autism spectrum disorder, and several psychiatric disorders, such as schizophrenia. One neurodevelopmental disorder that is associated with reduced hemispheric asymmetries, but for which findings on behavioral laterality are conflicting, is stuttering. Here, we report a series of meta-analyses of studies that report handedness (assessed as hand preference) levels in individuals who stutter (otherwise healthy) compared to controls. For this purpose, articles were identified via a search in PubMed, Scopus, and PsycInfo (13 June 2023). On the basis of k = 52 identified studies totaling n = 2590 individuals who stutter and n = 17,148 controls, five random effects meta-analyses were conducted: four using the odds ratio [left-handers (forced choice); left-handers (extreme); mixed-handers; non-right-handers vs. total)] and one using the standardized difference in means as the effect size. We did not find evidence of a left (extreme)- or mixed-handedness difference or a difference in mean handedness scores, but evidence did emerge, when it came to left-handedness (forced-choice) and (inconclusively for) non-right-handedness. Risk-of-bias analysis was not deemed necessary in the context of these meta-analyses. Differences in hand skill or strength of handedness could not be assessed as no pertinent studies were located. Severity of stuttering could not be used s a moderator, as too few studies broke down their data according to severity. Our findings do not allow for firm conclusions to be drawn on whether stuttering is associated with reduced hemispheric asymmetries, at least when it comes to their behavioral manifestation. [ABSTRACT FROM AUTHOR]

Stuttering is a speech disorder characterized by frequent and significant problems with normal fluency and flow of speech. People who stutter perceive themselves as poor communicators and develop negative speech attitudes. This development of a negative communicative attitude could be related to the expectations and high demands made by their parents about fluency. When these expectations exceed the stuttering individual’s abilities to produce fluent verbal communication, a stuttering episode occurs. This is perceived by the individual as a communicative performance not adequately meeting the requests. Consequently, these individuals often resort to various avoidance and escape behaviors and generally avoid discussing their experiences and feelings related to stuttering. Therefore, stimulating communication is essential during speech therapy sessions to expose experiences otherwise kept hidden both from children/adolescents and their parents. However, encouraging communication is far from simple. In an attempt to facilitate communication and foster a more effective relationship between persons who stutter and their parents, we implemented the so-called awareness drawing according to the IARA model at the opening of the stuttering assessment session. Fourteen children (M=10; F=4; mean age=10.42; SD=1.65) and eight adolescents (M=6; F=2; mean age = 15.25; SD=1.03) diagnosed with stuttering were involved in this study, along with their relatives (28 parents; M=10; F=18; mean age=31.14; SD=4.66 years). The results of the study revealed that the drawings and comments of children and adolescents with stuttering, along with their parents, can offer valuable insights into their experiences and perceptions of stuttering. Children and adolescents expressed a desire for acceptance and a wish to be recognized beyond their stuttering. They depicted solutions that encompass the involvement of both parents and speech therapists. The utilization of awareness drawing can have a substantial impact on speech therapists. During the stuttering assessment session, it can provide valuable insights into the emotions, thoughts of person who stutter, as well as the experiences of their parents. This, in turn, can enhance the design of therapeutic intervention.

In this research paper we show results from our experiments on creating a binary classifier for stammering identification in Hindi speech data. We train several Sequential CNN models with parametric adjustments such as color, image size, and training data shape changes to tweak classification performance. Our experimental pipeline converts speech samples into spectrograms using Librosa, and trains the Sequential CNN classifier on the image data using TensorFlow Lite. Our classification models achieve more than 95% accuracy in this classification task. [ABSTRACT FROM AUTHOR]

Introduction: Research reveals the clinical efficacy of both verbal and written stuttering disclosure statements provided by a child who stutters (CWS) and his advocates (i.e., mother or teacher) [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745–60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031–1048]. Although existing data reveal that both the source (i.e., self- vs. advocate disclosure) and modality (i.e., verbal or written) of stuttering disclosure yields significant improvements in the perceptions of speech skills and personality characteristics of CWS, there is a paucity of research directly comparing the modality (verbal vs. written) and source (self, mother, teacher) of disclosure statements. Accordingly, this study analyzes listeners' perceptions of a 12-year-old male CWS' speech skills and personal characteristics, as a function of both the source and modality of factual stuttering disclosure statements [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745–60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031–1048]. Methods: A total of 641 college-aged adults participated in this analysis; study participants reported their perceptions of speech skills and personality characteristics of a 12-year-old CWS as a function of stuttering disclosure. Participants were randomly assigned to view one video containing one of two disclosure modalities (verbal or written), one of three stuttering disclosure source conditions (self-disclosure, mother disclosure, and teacher disclosure), or a no-disclosure control condition. Participants in the control group viewed a brief video of a 12-year-old CWS reciting a short reading passage; participants in the experimental groups viewed their assigned disclosure statement followed by the same video used in the control condition. Immediately following the video, all participants completed a survey quantifying their perceptions of the CWSs relative to his speech skills and personal characteristics. Results: Results reveal optimal results via verbal self-disclosure and verbal teacher disclosure. A limited number of nominally positive perceptual differences were noted within the written mother disclosure group, while written CWS self-disclosure yielded significantly negative perceptions of the CWS. Overall, verbal disclosures yield far more significant and desirable perceptions of CWS' speech skills and personal characteristics when compared to written stuttering disclosure. Discussion: Results of this analysis reveal that verbal stuttering disclosure is significantly more effective in improving listeners' perceptions of a CWS, when compared to written stuttering disclosures. Despite the widespread adoption of written communication over digital media (e.g., email and text messages), these data support the notion that face-to-face or video verbal stuttering disclosure provides the most desirable perceptual benefits for CWS. Within verbal stuttering disclosure, verbal self-disclosure appears to be the single best overall disclosure methodology relative to clinical application. [ABSTRACT FROM AUTHOR]

Background: Stuttering is an organic process utterance condition. This utterance condition is broken by prolongation of sounds and repetitions of part words and phrases. Speech constitution strategies facilitate the client to use a new way of oral communication in stutters. Objective: to determine the effects of prolongation of speech and syllable time speech on reduction of severity of stuttering in stuttering patients. Methods This Randomized clinical trial study design was conducted in National Institute of Rehabilitation Medicine Islamabad. A total of n=30 participants of both gender having developmental stuttering with age between 20-30 years were included in the study through purposive sampling. The n=30 participants were randomly divided in to Group A received prolonged speech protocol (PSP) and Group B received syllable time speech protocol. The data was collected using the Scale of rating severity of stuttering (SRSS) at baseline, after 6th weeks and after 12th weeks of training. The data was analyzed through SPSS-21. Results The mean age of the study participants was 22±2.05 years. The median number of sibling was 4(2), birth order 2.5(2) and age of onset was 4(1) years. With-in group analysis showed that the group received prolong speech protocol {F=25.24(2), p

Abstract Background Having a stammer can have a significant effect on a child’s social, emotional and educational development. With approximately 66,000 children in the UK having a stammer, there is a need to establish an adequate evidence base to inform clinical practice. We describe a feasibility trial to explore the effectiveness of a new therapy programme for children aged 8–14: Palin Stammering Therapy for School Children (Palin STSC(8–14)). Preliminary data from the Michael Palin Centre, where the programme was developed, indicate that Palin STSC(8–14) is effective in reducing stammering frequency and impact for children, with beneficial effects for parents too. We will investigate the feasibility of the methods required for a definitive randomised controlled trial to investigate the application of this therapy by NHS speech and language therapists (SLTs), compared with ‘treatment as usual’ (TAU), beyond the specialist context in which it was developed. Methods This is a two-arm feasibility cluster-randomised controlled trial of Palin STSC(8–14) with TAU control arm, and randomisation at the level of the SLT. Quantitative and qualitative data will be collected to examine the following: the recruitment and retention of therapists and families, the acceptability of the research processes and the therapeutic intervention and the appropriateness of the therapy outcome measures. Assessments will be completed by children and parents at baseline and 6 months later, including measures of stammering severity; the impact of child’s stammering on both children and parents; child temperament, behaviour and peer relations, anxiety; quality of life; and economic outcomes. There will also be a qualitative process evaluation, including interviews with parents, children, SLTs and SLT managers to explore the acceptability of both the research and therapy methods. Treatment fidelity will be examined through analysis of therapy session records and recordings. Discussion The findings of this feasibility trial will inform the decision as to whether to progress to a full-scale randomised controlled trial to explore the effectiveness of Palin STSC(8–14) when compared to Treatment as Usual in NHS SLT services. There is a strong need for an evidence-based intervention for school age children who stammer. Trial registration ISRCTN. ISRCTN17058884 . Registered on 18 December 2019.

The inclusion of technologies such as telepractice, and virtual reality in the field of communication disorders has transformed the approach to providing healthcare. This research article proposes the employment of similar advanced technology – social robots, by providing a context and scenarios for potential implementation of social robots as supplements to stuttering intervention. The use of social robots has shown potential benefits for all the age group in the field of healthcare. However, such robots have not yet been leveraged to aid people with stuttering. We offer eight scenarios involving social robots that can be adapted for stuttering intervention with children and adults. The scenarios in this article were designed by human–robot interaction (HRI) and stuttering researchers and revised according to feedback from speech-language pathologists (SLPs). The scenarios specify extensive details that are amenable to clinical research. A general overview of stuttering, technologies used in stuttering therapy, and social robots in health care is provided as context for treatment scenarios supported by social robots. We propose that existing stuttering interventions can be enhanced by placing state-of-the-art social robots as tools in the hands of practitioners, caregivers, and clinical scientists.

Ronny Someck's poetry is unique in that it translates canonical Hebrew poetry into popular poetry. It is especially visible in the intertextual relations that Someck's poetry constructs with Yehuda Amichai's canonic poetry. Following Marx, the article analyses Someck's poetry as commodity structure as fetish. Someck brilliantly—and broadly—utilizes the figure of the stereotype; but in contrast with the accepted norm, he relies on the contradiction at the basis of the fetish to write subversive political poetry. Avoiding the binarism existing between resistance and affirmation, in his poems Someck develops a dialectic discourse that keeps rewriting the popular text as commodity existing in the circular rotation of selling and buying. This dialectic is manifested in the mode in which the fluid, hyphenated Arab-Jewish identity is represented in his poems. Through his poetry, Someck constitutes an inexhaustible space that allows the poems to develop subversiveness, which operates under the false appearance of total, coherent spaces. As part of Israeli culture, it could have been expected that this poetry would be stereotypical, adopting an Orientalist outlook. But Someck's poems develop, instead, an unstable gaze that undermines Orientalism's binarism. The lack of binarism is expressed in Someck's poems through a dual-layered structure; the two layers, one figurative and one literal, are separate and continuous and carry out complex interrelations. Within this relational frame the literal, violent layer punctures the figurative layer, and then materializes via political violence. But instead of relating to the Israeli occupation as an arena of a binary confrontation between the Israeli army and the Palestinians, it relies on its Mizrahi identity to destroy this binarism, and thus develops a flexible moral and political stance. Through writing his poetry as a "minor literature," Someck can maneuver between its two linguistic options—deterritorialization on one hand and reterritorialization on the other. A very impressive example is the poem about the Israeli Arab-Druze poet Samih El Kasem, in which he highlights the poet's guitar-playing in Hebrew as a major language. The deterritorialization in Samih El Kasem's poetry is expressed in the subversive deterritorialization of Someck's poem. The linguistic deterritorialization is visible when Someck defines his poetry as a stammer and thus gives voice to the oppressed and the rebels. [ABSTRACT FROM AUTHOR]

We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET (n = 13) or be put on a waitlist (n = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering.

Introduction Stuttering is a common occurrence in children which is also known as stammering, dysfluency or clutching of words. Aims of present study was to study association of age of onset and family history of stuttering with stutterers characteristics. Materials and Methods Total 136 stutterers were included in the study. All stutterers were subjected to complete ear nose and throat examination. All stutterers were evaluated by speech language therapist for diagnosis of speech disorder. Results Out of 136 stutterers 124 (91%) were male while 12 (9%) were female ranging from 6 years to 56 years, 15 (11%) had age of onset below 3 years, 98 (72%) had 3 years to 6 years while 23 (17%) had onset after age of 6 years, 44 (36.4%) male and 1 (8.3%) female patient had first degree family history of stuttering, 15 (11%) had mild stuttering, 98 (72%) had moderate stuttering while 23 (17%) had severe stuttering, 102 (75%) had secondary stuttering characteristics including 94 (75.8%) male and 8 (67%) female stutterers. Conclusion Present study concluded that there is definite association of between age of onset and severity of stuttering, between duration of stuttering and secondary characteristics and between severity and number of secondary characteristics of stuttering. We couldn’t find significant association between positive family history of stuttering among first degree relatives and age of onset, severity and secondary characteristics of stuttering.

Background: Having a stammer can have a significant effect on a child's social, emotional and educational development. With approximately 66,000 children in the UK having a stammer, there is a need to establish an adequate evidence base to inform clinical practice. We describe a feasibility trial to explore the effectiveness of a new therapy programme for children aged 8–14: Palin Stammering Therapy for School Children (Palin STSC(8–14)). Preliminary data from the Michael Palin Centre, where the programme was developed, indicate that Palin STSC(8–14) is effective in reducing stammering frequency and impact for children, with beneficial effects for parents too. We will investigate the feasibility of the methods required for a definitive randomised controlled trial to investigate the application of this therapy by NHS speech and language therapists (SLTs), compared with 'treatment as usual' (TAU), beyond the specialist context in which it was developed. Methods: This is a two-arm feasibility cluster-randomised controlled trial of Palin STSC(8–14) with TAU control arm, and randomisation at the level of the SLT. Quantitative and qualitative data will be collected to examine the following: the recruitment and retention of therapists and families, the acceptability of the research processes and the therapeutic intervention and the appropriateness of the therapy outcome measures. Assessments will be completed by children and parents at baseline and 6 months later, including measures of stammering severity; the impact of child's stammering on both children and parents; child temperament, behaviour and peer relations, anxiety; quality of life; and economic outcomes. There will also be a qualitative process evaluation, including interviews with parents, children, SLTs and SLT managers to explore the acceptability of both the research and therapy methods. Treatment fidelity will be examined through analysis of therapy session records and recordings. Discussion: The findings of this feasibility trial will inform the decision as to whether to progress to a full-scale randomised controlled trial to explore the effectiveness of Palin STSC(8–14) when compared to Treatment as Usual in NHS SLT services. There is a strong need for an evidence-based intervention for school age children who stammer. Trial registration: ISRCTN. ISRCTN17058884. Registered on 18 December 2019. [ABSTRACT FROM AUTHOR]

Stuttering is a neurodevelopmental speech disorder wherein people suffer from disfluency in speech generation. Recent research has applied machine learning and deep learning approaches to stuttering disfluency recognition and classification. However, these studies have focussed on small datasets, generated by a limited number of speakers and within specific tasks, such as reading. This paper rigorously investigates the effective use of eight well-known machine learning classifiers, on two publicly available datasets (FluencyBank and SEP-28k) to automatically detect stuttering disfluency using multiple objective metrics, i.e. prediction accuracy, recall, precision, F1-score, and AUC measures. Our experimental results on the two datasets show that the Random Forest classifier achieves the best performance, with an accuracy of 50.3% and 50.35%, a recall of 50% and 42%, a precision of 42% and 46%, and an F1 score of 42% and 34%, against the FluencyBank and SEP-28K datasets, respectively. Moreover, we show that the machine learning-based approaches may not be effective in accurate stuttering disfluency evaluation, due to diverse variations in speech rate, and differences in vocal tracts between children and adults. We argue that the use of deep learning approaches and Automatic Speech Recognition (ASR) with language models may improve outcomes, specifically for large scale and imbalanced datasets. [ABSTRACT FROM AUTHOR]

Background Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life. Aims To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention. Methods A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention. Results Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work. Conclusions Stammering can have a negative impact of workers' job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention. [ABSTRACT FROM AUTHOR]

Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances.

The understanding of how stuttering is portrayed in the newspaper media has largely been ignored but plays a role in public perception of stuttering. A text pattern analysis, cross-sectional study was conducted based upon analyses of publicly available data. The text corpus were generated from the U.S. newspaper media during 1980–2018 (downloaded from the database U.S. Major Dailies by ProQuest). The text corpuses were analyzed using the Iramuteq software using the cluster analysis and Chi square tests. The newspaper data set had 970 texts (i.e., articles in the main corpus). The cluster analysis of the main corpus resulted in six clusters, which were named as: (1) music (2) sports (3) politics and economy (4) speech (5) cinema, and (6) general. The sub-corpus which was built based on aspects related to speech (i.e., cluster 4 in main corpus analysis) had 539 texts, which had at least one segment in sub-corpus. The cluster analysis of sub corpus resulted in four clusters, which were named as: (1) education and social support (2) personal aspects (3) aspects related to speech and (4) research and development. Time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980–2018. The study shows that stuttering has been presented in the media while discussing various elements including sports, arts and politics and economy, and speech. The aspects related to speech found media focuses on various elements including personal aspects, providing education and support, and providing new insights into research and development [ABSTRACT FROM AUTHOR]

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Speech disorders have been examined in the article. Types of speech disorders as well as causes of its emergence from the neuropsychological, speech therapy, pedagogical and psychological points of view, have been studied through theoretical analysis. Nonverbal approach to speech disorders correction has been proposed - body-oriented therapy. Methods of body-oriented therapy have been examined and described. Reich’s body-oriented psychotherapy, that helps to remove blocks from the oral segment, release the jaw, throat and neck clips, as well as F.M. Alexander’s integral movement method, owing to which psychotherapist had cured himself of aphasia, have been presented. Body-oriented methods of massage therapy, articulation and deep face massage, combination of nonverbal and verbal methods via speech synchronization with body movements – fingers of dominant arm have been studied. Techniques of the proposed methods of body-oriented therapy have been described.

This article explores the representation of Hebrew speech in Hebrew literature during the first decades of the twentieth century by focusing attention on Yosef Hayim Brenner's novel, Me-hathala (From the Beginning). The novel, situated in a Jewish colony in Palestine, was written at a time when Hebrew was only emerging as a spoken vernacular and the text repeatedly engages the act of stammering. Drawing on current work in dysfluency studies, I demonstrate that such an attention to stammering was a tool employed by Hebrew authors to present an ambivalent relationship to the transforming language. Reading Brenner's novel, which mocks its protagonists' ineloquent Hebrew, the article suggests that Brenner's literary poetics be considered as a poetics of stammering, which demonstrates an iterated enactment of transition and negotiates contradictory drives in the fantasy of a national and linguistic revival. [ABSTRACT FROM AUTHOR]

The death of a child is typically seen as incommensurate, a limit-experience defying articulation and comprehension. In her most recent book, Literature in the Ashes of History (2013), the literary critic and trauma theorist Cathy Caruth theorizes a history that inscribes itself in and through its own (self-conscious, and traumatic) self-effacement; what is striking is that her attempt to theorize and initiate what she calls ‘a new kind of language’, produced ‘After the End’ (as she titles the second part of the book), must thus be understood not only in relation to the post-Holocaust world, but also in the context of the more personal, individual trauma of the loss of a child. This article seeks to explore Caruth’s notion of a different kind of language through analysis of two French fictional representations of the death of a child published in this century: Marie Darrieussecq’s novel Tom est mort, and Hélène Cixous’s autofictional novel, Le Jour où je n’étais pas là (2000). I read these texts (which both explicitly locate writing ‘after the end’) alongside Caruth’s Literature in the Ashes of History to contemplate what it might mean to write ‘after the end’. Tom est mort, I argue, experiments with linguistic form, self-consciously stammering — in a manner curiously similar to Caruth’s — in its attempt to express the impact of the death of a child on the mother (and on her language). Cixous’s text, by contrast, gives voice to the mother’s impossible mourning through figures of absence and lack. The ‘new language’ announced by Caruth is in these texts not a new language in itself, rather a language that is articulated in and through its own erasure, disintegration and absence, that ‘undoes’ its subject even as it gives voice to it, and locates itself after an end that cannot be defined. [ABSTRACT FROM AUTHOR]

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances. [ABSTRACT FROM AUTHOR]

Michelle A Donaghy,1 Kylie A Smith,2,3 1Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, 2Murdoch Childrens Research Institute, Royal Childrens Hospital, 3Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia Abstract: Stuttering is a speech disorder, with onset often occurring in the preschool years. The prevalence of stuttering in young children is much higher than that in the general population, suggesting a high rate of recovery. However, we are unable to predict which children will recover without treatment, and it is widely acknowledged that stuttering therapy during childhood provides the best safeguard against chronic stuttering. This review reports on current evidence-based stuttering treatment options for preschoolers through to adolescents. We discuss the clinical challenges associated with treating pediatric clients who stutter at different stages of development and explore potential areas of treatment research that might serve to advance current clinical practice in the future. Keywords: stuttering, stammering, pediatric, therapy, evidence based

In the period c.1660-1800, there was an unprecedented interest in the spoken word in Britain, and for those who aspired to be polite, a new emphasis upon the sounds of their speech. But what did this mean for the lives of those who stammered, stuttered or had a lisp? How far were speech impediments experienced or viewed as disabilities? This article argues that in their quest for polite manners and refinement, the socially ambitious were prepared to invest time and money upon improving their speech. This created demand for the services of speech specialists, a new occupational group who forged their identity during this time. The consequences of their advertising techniques, which suggested that speech impediments could and should be overcome, are explored. Finally, this article examines how polite society set standards for listening and responding to the sounds of people with speech impediments. [ABSTRACT FROM AUTHOR]

Purpose Although considerable efforts have been made to investigate the effectiveness of pharmacological treatments for stuttering, little is known about how the stuttering community perceives these treatments. This study aimed to assess and quantify beliefs regarding pharmacotherapy for adults who stutter and to establish whether behavioural intentions to undertake treatment were related to these beliefs. Method An adapted version of the Beliefs about Medicine Questionnaire was completed by adults who stutter. Participants also reported perceptions of their stuttering including its overall impact, ratings of previous speech therapy, and behavioural intentions to initiate pharmacotherapy and speech therapy in future. Results Necessity and concern beliefs were distributed widely across the sample and in a pattern indicating a relatively balanced perception of the benefits and costs of medication prescribed specifically for stuttering. Of the study’s measures, the necessity-concerns differential most strongly predicted the behavioural intention to initiate pharmacotherapy. The overall impact of stuttering predicted intentions to seek both pharmacotherapy and speech therapy. Participants reported the likelihood of pursuing pharmacotherapy and speech therapy in equal measure. Conclusions The theoretical model of medication representations appears to be a useful framework for understanding the beliefs of adults who stutter towards the medical treatment of their disorder. The findings of this study may be of interest to clinicians and researchers working in the field of stuttering treatment and to people who stutter considering pharmacotherapy. [ABSTRACT FROM AUTHOR]

See Crinion (doi:10.1093/brain/awy075) for a scientific commentary on this article.Stuttering is a neurodevelopmental condition affecting 5% of children, and persisting in 1% of adults. Promoting lasting fluency improvement in adults who stutter is a particular challenge. Novel interventions to improve outcomes are of value, therefore. Previous work in patients with acquired motor and language disorders reported enhanced benefits of behavioural therapies when paired with transcranial direct current stimulation. Here, we report the results of the first trial investigating whether transcranial direct current stimulation can improve speech fluency in adults who stutter. We predicted that applying anodal stimulation to the left inferior frontal cortex during speech production with temporary fluency inducers would result in longer-lasting fluency improvements. Thirty male adults who stutter completed a randomized, double-blind, controlled trial of anodal transcranial direct current stimulation over left inferior frontal cortex. Fifteen participants received 20 min of 1-mA stimulation on five consecutive days while speech fluency was temporarily induced using choral and metronome-timed speech. The other 15 participants received the same speech fluency intervention with sham stimulation. Speech fluency during reading and conversation was assessed at baseline, before and after the stimulation on each day of the 5-day intervention, and at 1 and 6 weeks after the end of the intervention. Anodal stimulation combined with speech fluency training significantly reduced the percentage of disfluent speech measured 1 week after the intervention compared with fluency intervention alone. At 6 weeks after the intervention, this improvement was maintained during reading but not during conversation. Outcome scores at both post-intervention time points on a clinical assessment tool (the Stuttering Severity Instrument, version 4) also showed significant improvement in the group receiving transcranial direct current stimulation compared with the sham group, in whom fluency was unchanged from baseline. We conclude that transcranial direct current stimulation combined with behavioural fluency intervention can improve fluency in adults who stutter. Transcranial direct current stimulation thereby offers a potentially useful adjunct to future speech therapy interventions for this population, for whom fluency therapy outcomes are currently limited. [ABSTRACT FROM AUTHOR]

James Braid (1795-1860), the natural philosopher, gentleman scientist, the inquisitive and sagacious, structured thinker, the safe, innovative, and efficacious surgeon--renowned for his personal character, range of surgical skills, and overall clinical excellence (especially in the treatment of dangerous and difficult forms of disease, and the correction of deformities such as club-foot, spinal curvature, knock knees, bandy legs, squint, etc.)--the early adopter (and advocate) of ether anaesthesia and, significantly, the originator of scientific hypnotism and the intentional use of structured suggestion has, to a large extent, been written out of history. This article examines Braid's schooling, his apprenticeship as both surgeon and apothecary, his university training, and his interactions with colleagues; and how these, combined with his scientific and intellectual interests, and his professional challenges, came together in Mr. James Braid, surgeon (aged 46)--the 'right man' at the 'right time'--who encountered Charles Lafontaine, in Manchester, in November 1841. [ABSTRACT FROM AUTHOR]

This article considers the challenges encountered by a recently appointed assistant programme leader in establishing an identity as a leader of an EdD programme. In discussing literature on the development of the EdD, the article recognizes an existing concern with student identity but highlights a need to consider the development of the EdD leader’s identity as a leader. Employing a reflexive narrative, the article emphasizes the centrality of the leader’s disabled identity in considering the role of assistant programme leader and thus becoming a leader. The EdD is identified as a social space where colleagues are often engaged in their professional learning with the EdD leadership team providing support. This article tracks some of the commonplace behaviours around such learning in a post-1992 institution, and discusses the implications for EdD leadership and management teams when trying to consider and implement changes to established organizational cultures. [ABSTRACT FROM AUTHOR]

Purpose The experience of passing as fluent, also called covert stuttering, has been uncritically framed as an inherently negative pursuit. Historically passing has been understood as a repression of one’s true, authentic self in response to either psychological distress or social discrimination. The authors of this paper seek a more nuanced understanding of passing. We ask, how must a person relate to herself in order to pass as fluent? Methodology This is a qualitative research study in which the authors utilized the ethical theories of philosopher Michel Foucault to contextualize data obtained from semi-structured interviews with nine participants who pass as fluent. Results Rather than a repression of an authentic self our data suggests passing is more usefully understood as a form of resistance by people who stutter to a hostile society. Participants learned from experiences of delegitimization that their stuttering had ethical ramifications. Consequently, they used a variety of self-forming practices to pass and thereby achieve the privileges that come with perceived able-bodiedness. Conclusion Passing as fluent is not an inauthentic form of stuttering but a form of stuttering that is produced through the use of specific technologies of communication. These technologies of communication are constituted by the unique ethical relationship of the person who stutters with herself. Passing can be understood as an active form of resistance rather than a passive form of repression. By theorizing passing as fluent as an ethical relationship, we open up the possibility of changing the relationship and performing it differently. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the effectiveness of digital manipulation of thyroid cartilage (DMT) with Fluency Shaping Therapy (FST) for the management of stuttering in adults. METHODS: This randomized clinical trial was conducted in Speech-Therapy department of National Institute of Rehabilitation Medicine Islamabad. Twenty male adult patients were recruited in the current study through non-probability, convenience sampling. The participants were randomly allocated into two equal groups (n=10): DMT group & FST group. Scale of rating severity of stuttering was used to assess the severity level at baseline and after the completion of 24 training sessions. Three vowel approaches with four sets of 5-repetition each were performed for each vowel in DMT group. Training in FST group comprised of speech techniques like easy onset, prolongation of speech, continuous phonation and light articulatory contact in reading and conversation in three speaking situations (speaking with therapist, reading aloud and free conversation). RESULTS: Mean age of the participants in DMT group was 21.4±2.2 years and FST group was 20.9±3.2 years. At baseline, there was no significant difference between DMT and FST groups regarding the severity of stuttering (5.3±0.94 vs. 5.6±0.96; p=0.492). As a result of 12 weeks of treatment, both groups demonstrated significant improvement (p<0.001). There was no significant difference between the groups after intervention (4.6±1.26 vs 3.8±0.91; p= 0.12). CONCLUSION: Both DMT and FST techniques are equally effective in the management of stuttering in adults. Further large scale studies on adults and children of both genders are needed to compare effectiveness of DMT and FST. [ABSTRACT FROM AUTHOR]

Stuttering is a psychosomatic condition with a high degree of social dysfunction characterized by involuntary interruptions in the flow of speech. The etiology is considered to be multifactorial. Speech therapy is the first-line treatment, and therapeutic alternatives have been proposed with different pharmacological agents. In this case report, we describe the use of botulinum toxin type A (BTX-A) in the facial muscles for treating a patient with developmental stuttering which showed a significant temporary improvement after undergoing the procedure. This is a single-subject study. In the current medical literature, there are a few descriptions of using BTX-A injections in the intrinsic laryngeal muscles with favorable results, but no reports of its use in facial muscles for the treatment of stuttering. Therefore, this report may be important to highlight BTX-A as a safe and effective option when managing to stutter. Hopefully, it will assist in the search for effective treatment and form part of the multi-disciplinary approach in the treatment of stuttering, helping these patients to reduce their social dysfunction and improve their speech and their lives. [ABSTRACT FROM AUTHOR]

Background: Despite many years of research, there is no certainty regarding the cause of stuttering. Although numerous interventions have been developed, a broad-based systematic review across all forms of intervention for adults and children was needed including views and perceptions of people who stutter. Objective: The aims of the study were to report the clinical effectiveness of interventions for people who stutter (or clutter), to examine evidence regarding the views of people who stutter and the views of professionals regarding interventions. Data sources: A systematic review of quantitative and qualitative literature was carried out between August 2013 and April 2014. The following electronic databases were searched: (1) MEDLINE, (2) EMBASE, (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database and NHS Economic Evaluations Database), (4) PsycINFO, (5) Science Citation Index, (6) Social Science Citation Index, (7) Cumulative Index to Nursing and Allied Health Literature, (8) ASSIA, (9) Linguistics and Language Behavior Abstracts, (10) Sociological Abstracts and (11) the EPPI Centre. Reference lists of included papers and other reviews were screened and also key journals in the subject area were hand-searched. Review methods: The searches aimed to identify (1) evidence of clinical effectiveness in populations of pre-school children, school-aged children, adolescents and adults, and (2) data relating to perceptions of barriers and facilitators to intervention clinical effectiveness among staff and people who stutter. A metasynthesis of the two linked elements via development of a conceptual model was also carried out to provide further interpretation of the review findings. Results: A systematic search of the literature identified a large number of potentially relevant studies. Of these, 111 studies examining the clinical effectiveness of interventions, 25 qualitative papers and one mixed-methods paper met the criteria for inclusion in this review. Review of the effectiveness literature indicated evidence of positive outcomes across all types of interventions. Virtually all evidence we identified reported at least some positive effect for some participants. However, there was evidence of considerable individual variation in outcome for study participants. The qualitative literature highlighted the need for programmes to be tailored to individual need with variation at the levels of the intervention, the individual and interpersonal/social elements. Metasynthesis of the data highlighted the complexity of elements that need to be considered in evaluation of long-term impacts following stuttering interventions. Limitations: Around two-thirds of the studies were considered to be at higher risk of bias. The heterogeneous nature and variability in outcomes meant that we were unable to complete a meta-analysis. Conclusions: Although much of the evidence we identified was from studies at risk of bias, it is suggested that most available interventions for stuttering may be of benefit to at least some people who stutter. There is a requirement for greater clarity regarding what the core outcomes following stuttering intervention should be and also enhanced understanding of the process whereby interventions effect change. Further analysis of those for whom interventions have not produced a significant benefit may provide additional insights into the complex intervention–outcomes pathway. Study registration: This study is registered as PROSPERO CRD42013004861. Funding: The National Institute for Health Research Health Technology Assessment programme.

As final year medical students, we have had first‐hand experience of the significant addition that simulation‐based learning can provide for healthcare education. After reading the 2021 paper 'Speech–language pathology students' perceptions of simulation‐based learning experiences in stuttering' by Penman et al., we were shown once again the benefits of simulation‐based learning. Having said that, we felt there were many crucial aspects omitted in the simulation‐based learning program created by Penman et al. for this research article. Therefore, we attempt to highlight these issues with the hope that as students also studying towards a career in healthcare, we can build on the well‐developed program created by Penman et al. and make educators aware of the possible areas of improvement in healthcare education. [ABSTRACT FROM AUTHOR]

Background A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. Aims To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. Methods & Procedures We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out. Main Contribution Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes. Conclusions & Implications A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs. [ABSTRACT FROM AUTHOR]

We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET ( n  = 13) or be put on a waitlist ( n  = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Chard, Van Zalk and Picinali.)

Background The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad-based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities. Aims To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non-pharmacological interventions for the management of developmental stuttering. Methods & Procedures A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed. Main Contribution The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions). Conclusions This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention. [ABSTRACT FROM AUTHOR]

Background: Client opinions are appropriate contributions to the design and evaluation of health care services. Adults who stammer (AWS) have previously in formed discussion regarding speech and language therapy (SLT) services; however, contemporary UK perspectives are lacking. Aim: This study aimed to identify features of helpful and unhelpful SLT services for AWS from the client and potential user perspective. Highlighting preferred components of therapy from this standpoint can help to ensure that SLT services are client-centred. Methods: An online survey was conducted using questions largely derived from UK professional guidelines of minimum best practice. Responses were subjected to quantitative and qualitative analysis. Results: Both positive and negative aspects of individual and group therapy for AWS were identified. Ideal service characteristics related to 'therapy and therapist' and 'service delivery' issues. Results were generally consistent with previous similar studies. In addition, consideration of the place of remote communication methods with in therapy highlighted an appetite for such practice. Conclusions: SLT facilitated long-term benefits for the majority of respondents, but future service design could incorporate greater flexibility in the: timing of therapy; therapeutic format; choice of therapist; and use of technology. The relevance of these findings for allied health services is acknowledged. [ABSTRACT FROM AUTHOR]