A fNIRS Investigation of Speech Planning and Execution in Adults Who Stutter - NEUROCIÊNCIAS
Neuroscience. 2019 Mar 6. [Epub ahead of print]
Jackson ES, Wijeakumar S, Beal DS, Brown B, Zebrowski P, Spencer JP.
New York University, New York, NY, University of Stirling, Stirling, Scotland, UK; Holland Bloorview Kids Rehabilitation Hospital, Ontario; University of Toronto, Toronto, ON; University of Wisconsin-Eau Claire, WI; Wendell Johnson Speech and Hearing Center, Iowa City, Iowa; University of East Anglia, Norwich, UK.
Our study aimed to determine the neural correlates of speech planning and execution in adults who stutter (AWS). Fifteen AWS and 15 controls (CON) completed two tasks that either manipulated speech planning or execution processing loads. Functional near-infrared spectroscopy (fNIRS) was used to measure changes in blood flow concentrations during each task, thus providing an indirect measure of neural activity. An image-based reconstruction technique was used to analyze the results and facilitate their interpretation in the context of previous functional neuroimaging studies of AWS that used positron emission tomography (PET) or functional magnetic resonance imaging (fMRI). For planning, we compared neural activity associated with high versus low planning load in AWS and CON. For execution, we compared the neural activity associated with overt versus covert naming in AWS and CON. Broadly, group level effects corroborate previous PET/fMRI findings including under-activation in left-hemisphere perisylvian speech-language networks and over-activation in right-hemisphere homologues. Increased planning load revealed atypical left-hemisphere activation in AWS, whereas increased execution load yielded atypical right fronto-temporo-parietal and bilateral motor activation in AWS. Our results add to the limited literature differentiating speech planning versus execution processes in AWS.
PMID: 30851356 DOI: 10.1016/j.neuroscience.2019.02.032
A single case report of a patient with stuttering who improved after open label TMS. - NEUROCIÊNCIAS
Brain Stimul. 2019 Jan 19. [Epub ahead of print]
Mejías G, Prieto J.
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
No abstract available.
PMID: 30704893 DOI: 10.1016/j.brs.2019.01.011
An exploratory factor analysis of action responses to stuttering anticipation - TERAPIA
J Fluency Disord. 2019 Mar 7;60:1-10. [Epub ahead of print]
Jackson ES, Rodgers NH, Rodgers DB.
New York University, New York, NY, United States; University of Iowa, Iowa City, IA, United States.
PURPOSE: We previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356-370) - a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.
METHODS: A total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.
RESULTS: A three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).
CONCLUSION: Understanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.
PMID: 30875585 DOI: 10.1016/j.jfludis.2019.03.001
Abnormal neural response to phonological working memory demands in persistent developmental stuttering - NEUROCIÊNCIAS
Hum Brain Mapp. 2019 Jan;40(1):214-225. Epub 2018 Aug 26.
Yang Y, Jia F, Fox PT, Siok WT, Tan LH.
Shenzhen University, Shenzhen, China; Shenzhen Institute of Neuroscience, Shenzhen, China; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of Hong Kong, Pokfulam Road, Hong Kong.
Persistent developmental stuttering is a neurological disorder that commonly manifests as a motor problem. Cognitive theories, however, hold that poorly developed cognitive skills are the origins of stuttering. Working memory (WM), a multicomponent cognitive system that mediates information maintenance and manipulation, is known to play an important role in speech production, leading us to postulate that the neurophysiological mechanisms underlying stuttering may be associated with a WM deficit. Using functional magnetic resonance imaging, we aimed to elucidate brain mechanisms in a phonological WM task in adults who stutter and controls. A right-lateralized compensatory mechanism for a deficit in the rehearsal process and neural disconnections associated with the central executive dysfunction were found. Furthermore, the neural abnormalities underlying the phonological WM were independent of memory load. This study demonstrates for the first time the atypical neural responses to phonological WM in PWS, shedding new light on the underlying cause of stuttering.
PMID: 30145850 DOI: 10.1002/hbm.24366
After the RESTART trial: six guidelines for clinical trials of early stuttering intervention. - OUTRAS ÁREAS
Int J Lang Commun Disord. 2019 Feb 17. [Epub ahead of print]
Onslow M, Lowe R.
The University of Sydney, Sydney, NSW, Australia.
BACKGROUND: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter.
AIMS: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention.
METHOD: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning.
MAIN CONTRIBUTION: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development.
CONCLUSION: In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.
PMID: 30773736 DOI: 10.1111/1460-6984.12463
An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders - EMOCIONAL
J Commun Disord. 2019 Feb 15;78:69-83. [Epub ahead of print]
Druker KC, Mazzucchelli TG, Beilby JM.
Curtin University, Western Australia, Australia.
PURPOSE: The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes.
METHODS: This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment.
RESULTS: Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only.
CONCLUSION: Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.
PMID: 30798143 DOI: 10.1016/j.jcomdis.2019.02.002
Are variants in sex hormone metabolizing genes associated with stuttering? - GENÉTICA
Brain Lang. 2019 Feb 21;191:28-30. [Epub ahead of print]
Frigerio Domingues CE, Grainger K, Cheng H, Moretti-Ferreira D, Riazuddin S, Drayna D.
NIDCD/National Institutes of Health, Bethesda, MD 20892, USA; Sao Paulo State University, Botucatu, Brazil; Alama Iqbal Medical Research Center, Pakistan.
No abstract available.
PMID: 30798091 DOI: 10.1016/j.bandl.2019.02.003
Clozapine-Associated Myoclonus and Stuttering Secondary to Smoking Cessation and Drug Interaction: A Case Report. - FARMACOLOGIA
J Clin Psychopharmacol. 2019 Mar 28. [Epub ahead of print]
Chochol MD, Kataria L, OʼRourke MC, Lamotte G.
Medstar Georgetown University Hospital Washington, DC; George Washington University Hospital Washington, DC
PMID: 30925500 DOI: 10.1097/JCP.0000000000001032
No abstract available
Differences in the relation between temperament and vocabulary based on children's stuttering trajectories - EMOCIONAL
J Commun Disord. 2019 Jan 25;78:57-68. [Epub ahead of print]
Singer CM, Walden TA, Jones RM.
Vanderbilt University, Nashville, TN, United States
PURPOSE: The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter.
METHODS: Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire.
RESULTS: For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association.
CONCLUSION: These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.
PMID: 30771599 DOI: 10.1016/j.jcomdis.2019.01.004
Disfluency clusters in speakers with and without neurogenic stuttering following traumatic brain injury - GAGUEIRA ADQUIRIDA
J Fluency Disord. 2019 Jan 11;59:33-51. [Epub ahead of print]
Penttilä N, Korpijaakko-Huuhka AM, Kent RD.
University of Tampere, Tampere, Finland; University of Wisconsin-Madison, Madison WI, United States.
PURPOSE: Analyze the characteristics and rate of disfluency clusters in adults with and without neurogenic stuttering after traumatic brain injury (TBI).
METHOD: Twenty adults with TBI participated in this study, including 10 with neurogenic stuttering (Group B) and 10 without -stuttering (Group A). Disfluency clusters in speech samples were classified into three types: Stuttering-like (SLD), other (OD), and mixed (MIX).
RESULTS: Speakers with and without neurogenic stuttering produced the same mean number of disfluency clusters. In addition, the mean length of clusters did not differ between these speaker groups although the longest clusters did. The most frequently occurring cluster type for people with neurogenic stuttering was MIX and OD for people without stuttering. Although the speakers in Group A produced stuttering-like disfluencies, these never occurred together to form a SLD type cluster. For Group B, the starter units of the clusters were usually stuttering-like disfluencies, while for Group A, the starter units were mostly interruptions.
CONCLUSIONS: Compared to non-stuttering speakers, stuttering after TBI did not increase the number of clusters, but rather lengthened them. In speakers with neurogenic stuttering, the number and length of clusters were related to the manifestation of other communication deficits, not to the frequency of stuttering-like disfluencies. Still, SLD clusters occurred only in those people with neurogenic stuttering. These findings raise questions about the nature of both neurogenic stuttering and the dynamics of disfluency clustering.
PMID: 30641458 DOI: 10.1016/j.jfludis.2019.01.001
Dissociating motor-speech from lexico-semantic systems in the left frontal lobe: insight from a series of 17 awake intraoperative mappings in glioma patients - NEUROCIÊNCIAS
Brain Struct Funct. 2019 Jan 14.. [Epub ahead of print]
Corrivetti F, de Schotten MT, Poisson I, Froelich S, Descoteaux M, Rheault F, Mandonnet E.
Lariboisière Hospital, APHP, Paris, France; Université Paris, Paris, France; Université de Sherbrooke, Sherbrooke, Canada.
Functional brain mapping during awake surgery procedures is the gold standard technique in the management of left frontal lobe tumors. Nevertheless, a unified picture of the language subsystems encountered during left frontal lobe mapping is still lacking. We retrospectively analyzed the 49 cortical and the 33 axonal sites of functional language mapping performed in 17 patients operated for a left frontal lobe glioma under awake conditions. Sites were tagged on the postoperative MRI, based on anatomical landmarks and intraoperative photography. All MRIs and tags were then registered in the MNI template. Speech disturbances related to motor functions (speech arrest-with or without superior limb arrest-, stuttering, and vocalization) were grouped together as "motor-speech" responses. Anomias, semantic paraphasia, perseverations, and PPTT errors were classified as "lexico-semantic" responses. MNI-registered axonal sites were used as seed for computing disconnectome maps from a tractogram atlas of ten healthy individuals, as implemented in the BCB toolkit. The cortical distribution of lexico-semantic responses appeared to be located anteriorly (pars triangularis of the inferior frontal gyrus and posterior end of the middle and superior frontal gyrus) compared to motor-speech responses (lower end of the precentral gyrus and pars opercularis). Within the white matter, motor-speech responses and lexico-semantic responses overlapped on the trajectory of the aslant and fronto-striatal tracts, but the lexico-semantic sites were located more anteriorly (mean Y coordinate on the MNI system was 21.2 mm for lexico-semantic sites and 14.3 mm for the motor-speech sites; Wilcoxon test: W = 60.5, p = 0.03). Moreover, disconnectome maps evidenced a clear distinction between the two subsystems: posterior fronto-striatal and frontal aslant tracts, corpus callosum and cortico-spinal tract were related to the motor-speech sites, whereas anterior frontal aslant tract, inferior-fronto-occipital fasciculus (IFOF) and anterior thalamic radiations were related to the lexico-semantic sites. Hence, we evidenced distinct anatomical substrates for the motor-speech and lexico-semantic systems. Regarding the aslant/fronto-striatal system, an anterior to posterior gradient was found, with a lexico-semantic role for the anterior part and a motor-speech involvement for the posterior part. For tumors abutting the precentral sulcus, posterior boundaries of the resection are made of motor-speech sites, meaning that the anteriorly located lexico-semantic system is no more functional, as a result of network reorganization by plasticity.
PMID: 30637492 DOI: 10.1007/s00429-019-01827-7
Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement - OUTRAS ÁREAS
Int J Lang Commun Disord. 2019 Apr 2. [Epub ahead of print]
Namasivayam AK, Pukonen M, Goshulak D, Granata F, Le DJ, Kroll R, van Lieshout P.
University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; The Speech and Stuttering Institute, Toronto, ON, Canada; University of Toronto Mississauga, Mississauga, ON, Canada.
BACKGROUND: Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population.
AIMS: To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI.
METHODS & PROCEDURES: A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention.
OUTCOMES & RESULTS: Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions.
CONCLUSIONS & IMPLICATIONS: Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.
PMID: 30941860 DOI: 10.1111/1460-6984.12472
"I Stopped Hearing Voices, Started to Stutter" - A Case of Clozapine-Induced Stuttering. - FARMACOLOGIA
Indian J Psychol Med. 2019 Jan-Feb;41(1):97-98.
Free Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337922/#__ffn_sectitle
Nagendrappa S, Sreeraj VS, Venkatasubramanian G.
National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
No abstract available.
PMID: 30783319 PMCID: PMC6337922 DOI: 10.4103/IJPSYM.IJPSYM_157_18
Novel PANK2 mutation in a Chinese boy with PANK2-associated neurodegeneration: A case report and review of Chinese cases.- GENÉTICA
Medicine (Baltimore). 2019 Jan;98(4):e14122.
Zhang Y, Zhou D, Yang T.
West China Hospital, Sichuan University, Chengdu, China
RATIONALE: Pantothenate kinase-associated neurodegeneration (PKAN), also called Hallervorden-Spatz Syndrome (HSS), is a rare neurodegeneration with brain iron accumulation from pantothenate kinase 2 gene (PANK2) mutation characterized as extrapyramidal symptoms. However, few studies involving PKAN patients were reported in China. This study was conducted to identify the genetic mutations in a Chinese boy with PKAN, and to review all PANK2 mutations reported in Chinese cases with PKAN.
PATIENT CONCERN: We reported a 23-year-old Chinese boy with PKAN, exhibiting difficulty in writing and manipulation using right hand with slow progression for 12 years. He spoke with a severe stutter when he was 15 years old.
DIAGNOSIS: Considering results of magnetic resonance images, brain computed tomography and medical history, the case was suspected to be related to genetic factors.
INTERVENTIONS: Whole exome sequencing was arranged, and the mutations were identified in his parents' genome.
OUTCOMES: In the present study, whole exome sequencing revealed 2 novel mutations (c.1696C > G in exon 7 and c.1160_c.1161insG in exon3) of the PANK2 gene in the proband. c.1696C > G and c.1160_c.1161insG, respectively, were confirmed in his father and mother. We also reviewed 14 different PANK2 mutations, most of which were missense type in Chinese cases. Those mutations did not show apparent hotspots, but exon 3 and 4 were frequently involved.
LESSONS: Two novel compound heterozygous mutations were identified and considered to be pathogenic in PKAN patients. This review of the reports indicated that atypical PKAN is the more common phenotype in China and no apparent genotype-phenotype correlation was found.
PMID: 30681573 DOI: 10.1097/MD.0000000000014122
Reliability and validity of the UTBAS-TR (The Unhelpful Thoughts and Beliefs Scale-the Turkish version) in the Turkish population - AVALIAÇÃO
Int J Speech Lang Pathol. 2019 Mar 11:1-6.. [Epub ahead of print]
Aydın Uysal A, Ege P.
Kocaeli University , Kocaeli , Turkey and Ankara Speech and Language Therapy Center , Ankara , Turkey.
PURPOSE: This paper decribes the development of the Turkish adaptation of UTBAS (UTBAS-TR) and reports the results concerning its applicability and psychometric structure.
METHOD: The sample consisted of 81 males and 19 females diagnosed with developmental stuttering in two centres. Test-retest reliability score was obtained by correlating results of repeated aplications of the scale within a one-week interval and a paired t-test was calculated to see the differences in the total and UTBAS I, II and III scores. The internal consistency was assessed using the Cronbach's alpha. Construct validity was also assessed by examining inter-scale correlations and with the correlations of the UTBAS-TR with two other scales (State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI)).
RESULT: The internal consistency of the UTBAS-TR and the test and retest reliability score was statiıstically significant. The correlation between UTBAS-TR total score and the UTBAS-TR I, II and III correlations were high. A significant correlation was observed between UTBAS-TR total score with State Anxiety Inventory. However, the correlations between UTBAS-TR-Total Score and Trait Anxiety Inventory and Beck Anxiety Inventory were low.
CONCLUSION: The UTBAS-TR proved to be suitable for use with the Turkish population.
PMID: 30856006 DOI: 10.1080/17549507.2019.1568572
The lived experience of stuttering: a synthesis of qualitative studies with implications for rehabilitation - TERAPIA
Disabil Rehabil. 2019 Jan 29:1-11. [Epub ahead of print]
Connery A, McCurtin A, Robinson K.
University of Limerick , Limerick , Ireland; HSE Dublin South West , Dublin , Ireland.
PURPOSE: Stuttering is a chronic communication disorder resulting in challenging life experiences for many individuals. This review aimed to integrate qualitative findings on the lived experiences of people who stutter and identify implications for rehabilitation.
MATERIALS AND METHODS: A systematic literature search of electronic databases for studies published since 2000 was completed to identify research papers that used qualitative methods to explore the lived experiences of adults who stutter. Forty-five papers were read in full and a final seventeen papers were synthesised using a meta-ethnographic approach.
RESULTS: Five themes are described: (i) Avoidance is used to manage stuttering; (ii) Stuttering unfavourably impacts employment experiences; (iii) Stuttering shapes self-identity; (iv) Stuttering leads to negative reactions; and (v) Stuttering impacts relationships adversely.
CONCLUSIONS: This review identifies the profound and predominantly negative impact that stuttering has on individuals' experiences. Avoidance is a commonly used strategy to manage stuttering with further negative consequences for the individual. To promote person-centred care and enhance treatment outcomes, clinicians should be cognizant of the profound impact of stuttering on the individual's life experience and incorporate targeted goals to reflect this when intervening.
IMPLICATIONS FOR REHABILITATION Clinicians should be aware of and understand the extent of the impact of stuttering on an individual's life which is typified by various forms of avoidance and challenges in a number of domains including employment, identity formation, relationship development and others' perceptions of the person who stutters. An impairment-based approach to stuttering treatment with adults focusing on the overt aspects of stuttering (i.e., speech behaviours) is not holistic and does not do justice to the spectrum of covert features such as avoidance, and internalised thoughts and feelings that are associated with the condition. Therefore, the adoption of a holistic approach to stuttering intervention is recommended. An understanding of adults' lived experience of stuttering has the potential to inform programme developments for children and adolescents with the same condition and thus employ preventative strategies to reduce the development of negative life experiences at an earlier age. Clinicians should engage with the field of disability studies to strengthen their practice and consider their role in addressing socially-imposed barriers such as negative attitudes impacting on people who stutter.
PMID: 30696288 DOI: 10.1080/09638288.2018.1555623
The working alliance in stuttering treatment: a neglected variable? - TERAPIA
Int J Lang Commun Disord. 2019 Mar 13. [Epub ahead of print]
Sønsterud H, Kirmess M, Howells K, Ward D, Feragen KB, Halvorsen MS.
University of Oslo, Oslo, Norway; Department of Speech and Language Disorders, Oslo, Norway; Sunnaas Rehabilitation Hospital, Norway; Independent scholar, Wilmslow, UK; University of Reading, Speech Research Laboratory, Reading, UK; Oslo University Hospital, Centre for Rare Disorders, Oslo, Norway.
BACKGROUND: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular.
AIMS: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post-therapy.
METHODS & PROCEDURES: Eighteen adults (21-61 years) participated in this multiple single-case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory-Short Version Revised (WAI-SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST-E), the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A), the Wright & Ayre Stuttering Self-Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS).
OUTCOMES & RESULTS: Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post-treatment. The association between client-led goals and therapy tasks appeared particularly important.
CONCLUSIONS & IMPLICATIONS: The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client-clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.
PMID: 30866151 DOI: 10.1111/1460-6984.12465