ACQ Vol 12 no 1 2010

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Motor speech disorders
ACQ Volume 12, Number 1 2010 25
Keywords
adult
non-intensive
prolonged
speech
stuttering
treatment
This article
has been
peer-
reviewed
Wendy Lloyd
any of the measures, including stuttering frequency, rate of
speaking, treatment efficiency, treatment compliance, and
communication attitudes” (p. 392). This research suggests
that for some clients, treatment in a non-intensive format will
not be detrimental to treatment outcomes.
In addition, the intensive formats described by Harrison
et al. (1998) and O’Brian et al. (2003) include a number
of weekly sessions both pre and post the intensive day.
O’Brian, Packman, and Onslow (2008) and Carey, O’Brian,
Onslow, Block, and Jones (2009) have replaced the group
intensive component with home practice in their respective
telehealth studies of the Camperdown Program with no
detriment to treatment outcomes.
Clinicians need further information to know whether PS
treatment can be delivered in a non-intensive format and
what outcomes can be expected. This paper presents five
retrospective case studies of clients who were treated using
a one-hour weekly prolonged speech service delivery model.
Treatment outline
This one-hour weekly PS treatment was adapted from the
intensive formats of PS and in reference to Onslow and
Packman (1997). Adaptations were made with particular
consideration of those formats which included a reduced
intensive component, a number of weekly visits, transference
of PS in everyday life, and a maintenance phase. While a
number of the intensive programs include programmed
instruction, this weekly PS treatment was non-programmed.
There is some support to suggest that programmed
instruction is not necessary for some clients who learn PS
(O’Brian et al., 2003; Packman, Onlsow, & van Doorn, 1994).
Clients attended weekly 1-hour clinic visits. Beyond- and
within-clinic speech measures were routinely collected by the
clinician and client throughout the course of treatment and
were used to evaluate progress. These measures included:
• percentage of syllables stuttered (%SS)
• severity ratings (SR) (1 = no stuttering, 10 = extremely
severe stuttering)
• naturalness ratings (1 = very natural speech, 9 =
extremely unnatural speech)
The %SS measures were gathered within the clinic by
the clinician. The SR and naturalness scales were used as a
tool by both the clinician and client to describe within- and
beyond-clinic stuttering severity and speech naturalness.
During the course of treatment each client:
• established goals for treatment;
• learnt how to assign and use severity and naturalness
ratings;
The positive outcomes of various intensive
prolonged speech (PS) treatments in groups
are well documented in the literature.
However, these models of service delivery for
adults who stutter may be less viable in
generalist clinics due to clinician and group
requirements. Non-intensive PS treatment has
been researched, but outcome data are
lacking. This paper presents clinical outcomes
which were obtained from a retrospective file
audit of five clients. Each client’s goals were
achieved using PS treatment which was
delivered during one-hour weekly clinic visits.
Treatment was conducted as part of a routine
clinical caseload at the Stuttering Unit,
Bankstown Health Service. The viability of this
service delivery model for some adults who
stutter is discussed.
The outcomes of PS treatments delivered in various
intensive group formats are well documented (Onslow,
1996; Harrison, Onslow, Andrews, Packman, &
Webber, 1998; O’Brian, Onslow, Cream, & Packman, 2003;
Block, Onslow, Packman, Gray, & Dacakis, 2005). Some of
these intensive formats are characterised by multi-week or
week-long instatement phases. More recently developed
PS treatment programs (Harrison et al., 1998; O’Brian et al.,
2003) include a much shorter intensive component of only
one day. However, these programs still require a group of
clients to be able to participate in treatment concurrently, as
well as a minimum of two clinicians to be available for a full
day for the intensive component. This type of service delivery
may be difficult to provide in generalist clinics, due to the
availability of clinicians and clients.
Onslow and Packman (1997) have suggested that
prolonged speech treatment could potentially be delivered
in non-intensive formats, but acknowledged that there is
“little documentation to assist clinicians in formulating those
creative variations” (p. 358). James, Ricciardelli, Hunter,
and Rogers (1989) compared the outcomes of 20 adult
and adolescent participants who received PS treatment
in an intensive format to those who received treatment in
a non-intensive format (2 x two-hour sessions per week).
They reported that “at no stage, during or after treatment,
did either treatment format produce superior results on
Weekly prolonged speech
treatment for adults
Wendy Lloyd, Margaret Webber, Mary Erian, and Stacey Sheedy