ACQ Vol 12 no 1 2010

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ACQ Volume 12, Number 1 2010 27
C5 commenced the maintenance phase in visit 8.
Maintenance criteria was:
• BC: SRs of 1s and 2s
• WC: ≤ 1%SS with ≤ SR 2.
During the maintenance phase C5 practised once a week
or if he noticed any increases in severity. C5 competed the
maintenance phase in 7 visits over 6 months.
Client outcomes
All clients showed a significant drop in SRs and %SS scores
at the completion of the weekly treatment phase. Within
clinic %SS measures are represented in figure 1 and beyond
clinic severity measures are represented in figure 2. Average
weekly treatment time was 23 hours, with a range of 8 to 43.
All clients used PS at a naturalness level where they could
control stuttering. C1, C2, and C3 controlled their speech in
most situations at naturalness 1–2 (as judged by clinician
and client). C4 used naturalness 2–3 on a regular basis. No
specific naturalness data was recorded in C5’s final
maintenance visit. However, the clinician reported that C5
was observed to use minimal soft contacts in his speech.
The clients’ maintenance phase lasted for a period of
6–19 months during which time, four of the clients met
in conversation. In visit 11 C3 reported trying to use
naturalness 3 in all of his daily conversations. He continued
to practise varying his naturalness levels in reading and
specified practice conversations. Practice goals were also
set for his first language, Hindi.
C3 commenced the maintenance phase after visit 15.
Maintenance criteria were:
• BC: SRs < 3
• WC: ≤ 3%SS with SR ≤ 3.
In the seventh maintenance visit, C3 was reporting
difficulties using PS for lengthy conversations and on
the phone. As a result a decision was made to return to
treatment. C3 attended three fortnightly visits and then re-
entered maintenance with criteria set at:
• BC: SRs ≤ 4
• WC: SR ≤ 3 with %SS ≤ 4.
Nine more maintenance visits followed over a 16-month
period.
Client 4 (C4)
Initially PS was taught at naturalness 9 in words and
phrases. In visit 2 C4 was able to use naturalness 7–8 for
short phrases in conversation. C4 was encouraged to
choose a practice partner for his home practice and tape
recordings were regularly used to aid practice. By visit 5 C4
was varying his naturalness from 6 to 2 in 30 second
monologues and conversations. However, due to his severe
stutter, in following sessions it was necessary to work at
more unnatural levels in order for C4 to improve his
consistency in using PS. C4 was advised to practise at
home at naturalness levels 9, 6, and 3. In visit 10 he had an
increase in stuttering severity and it was necessary to return
to practising PS unnaturally in word lists. A few sessions
were required before C4 could return to using PS in
monologue at varied naturalness levels. By visit 14 C4 was
beginning to use some naturalness 2 and 3 in practise alone
and with his practice partner. The remainder of C4’s sessions
included practice at more unnatural levels but focused
mainly on improving his use of naturalness 3 and problem
solving around transferring his use of PS into daily situations.
C4 commenced the maintenance phase in visit 43.
Maintenance criteria consisted of:
• BC: average SRs ≤ 4, worst rating ≤ 6.
• WC: < 3%SS with SR ≤ 3; C4 was required to
demonstrate that he could maintain naturalness 2–3 in
monologue and five-minute conversation.
C4 completed maintenance in 9 visits over 19 months.
Client 5 (C5)
In his first visit C5 was able to demonstrate residual skills of
his previous treatment, smooth speech (a variant of PS). The
naturalness scale and concept of self-evaluation was
introduced. In visit 2 soft contacts (an element of PS) was
chosen as C5’s treatment technique as he did not need all
elements of PS to control his stuttering. Soft contacts were
initially practised in word lists (particularly with plosive
sounds) at naturalness 5 to 3. In visit 5, C5 was taught to
use soft contacts in monologue at naturalness 2. Home
practice consisted of practising soft contacts in word lists
and then in conversation with practice partner. Tape
recordings were utilised to provide models of soft contacts
and also to collect %SS and SR measures for beyond clinic
speech as this was reported to be higher than within clinic
speech. Across time the beyond clinic measures of C5’s
speech decreased significantly (16.5%SS and SR 8 to 0%SS
and SR 1).
Beginning of
treatment
30
25
20
15
10
5
0
SS %
C1
C2
C3
C4
C5
2.4
6.9
26.4
24.6
0.6
End of
treatment
1.6
2.0
0.6
0.7
0
End of
maintenance
0.1
1.9
3.8
0.8
0
Figure 1. WC %SS for all clients
Beginning of
treatment
10
9
8
7
6
5
4
3
2
1
Severity Rating
C1
C2
C3
C4
C5
3.7
6.8
8.7
8.0
3.7
End of
treatment
2.0
2.3
2.8
3.2
1.3
End of
maintenance
1.6
2.0
3.0
3.3
1.1
Figure 2: BC SRs*
* SRs were averaged for the week prior to the corresponding
clinic visit