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132 JCPSLP Volume 17, Number 3 2015 Journal of Clinical Practice in Speech-Language Pathology
engaging, realistic, consistent, convenient, motivating, and
meaningful.
While this paper has presented a description of the
roles technology plays in adult and adolescent stuttering
treatment, technology arguably may play as many or
more roles in stuttering treatment for children. In time,
technology is likely to drive the development of new and
creative treatments. Clinicians are, however, cautioned
that the ubiquitous nature of technology in our society
today presents the possibility that technology will be used
in clinical practice with insufficient care and thought. This
may pose a number of risks. First is the risk that technology
will be used with insufficient clinical evidence. Second is
the risk that there will be a lack of consideration of ethical
issues of telepractice, for example client confidentiality,
privacy, data security and transmission. Third is the legal
risk arising in some countries about whether and how
the right to engage in telepractice is established, when
clinicians work across state or national boundaries. Fourth
is the ethical risk of clinicians taking incomplete measures
to safeguard clients when online resources are used. It
will take collaboration, interest, and effort of clinicians,
researchers, program developers and our professional
organisations to address these risks, and others presented
to us as technology continues to evolve.
References
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Beeminder. (n.d.). Be Minded. Retrieved from https://
Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis,
G. (2005). Treatment of chronic stuttering: Outcomes from
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Boberg, E., & Kully, D. (1994). Long-term results of an
intensive treatment program for adults and adolescents
who stutter. Journal of Speech and Hearing Research, 37,
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Bothe, A. K., Davidow, J. H., Bramlett, R. E., & Ingham,
R. J. (2006). Stuttering treatment research 1970–2005: I.
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Bradberry, A. (1997). The role of support groups and
stuttering therapy. Seminars in Speech and Language, 18,
391–399.
Carey, B., O’Brian, S., Lowe, R., & Onslow, M. (2014).
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adolescents who stutter: A phase II trial. Language, Speech
and Hearing Services in Schools, 45, 314–324.
Carey, B., O’Brian S., Onslow, M., Block, S., Jones,
M., & Packman, A. (2010). Randomised controlled non-
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Erickson, S., Block, S., Menzies, R., Onslow, M., O’Brian,
S., & Packman, A. (2012). Stand-alone internet speech
can be tested by the demands of needing to attend clinic
on a weekly basis. Technology facilitates adherence and
makes therapy less onerous when phone or webcam
Internet consultations replace in-clinic appointments.
Of course for some clients, adherence will have been
facilitated from the outset through telepractice. Irrespective
then of where they occur, at these consultations clients,
together with the clinician, will begin to problem solve
challenges and determine how much practice is needed,
what type, and where in order to optimise progress.
Technology can also assist if motivation becomes an issue.
Introducing clients to a web-based motivational reward
system, for example Beeminder (n.d.), allows clients to set
goals, receive prompts, track practice, and even reward
themselves. Other computer applications may facilitate
adherence in other ways. HABITRPG (n.d., role play game)
is a video game application to help develop new habits. It
“gamifies” the life of the user by turning tasks (for example,
speech practice activities) into monsters they have to
conquer. The better the user is at sticking to a goal, the
more progress is made in the game. New alternatives are
likely to continue to become available. These applications
are particularly suitable for adolescents as this population is
likely to be very familiar with technology and find it enjoyable.
Stage IV: Maintenance
During the maintenance stage, clients continue to develop
problem-solving skills to assist maintenance of their
behaviour change over time. The aim is to reduce reliance
on the clinician and to increase client self-reliance to deal
with fluctuations in stuttering.
There are different ways technology can be used here.
First, webcams can assist clients to be involved in self-
help groups, and to attend them more regularly, even
when time and distance are an issue. Self-help groups
may provide support and encouragement as well as an
opportunity for speech practice. There is evidence that
support groups can benefit psychological well-being in
people with chronic mental illness, depression, anxiety, and
bereavement (Pistrang, Barker, & Humphreys, 2008), and in
people who stutter (Bradberry, 1997). The groups may also
provide added opportunity for speech practice when family
members or friends are included.
A second way that technology can be used is by allowing
consultations to continue with minimal inconvenience to
the client, through telepractice consultations. Stuttering is a
relapse-prone disorder and failure to complete maintenance
stages of treatment places clients at increased risk of this
occurring. Maintenance of gains may therefore be facilitated
in this manner. Finally, technology provides the opportunity
for clients to capture examples of their own speech
restructuring technique, for them to continue to observe
and evaluate, as described during the generalisation stage.
Self-evaluation of speech is a prerequisite to effective self-
management. Technology enables this process to occur
with minimum effort and maximum validity.
Conclusion
This paper has presented some options for incorporating
technology into practice. Using the Camperdown Program
as an illustration, it has described how technology
permeates that clinical practice, well beyond the realm of
telepractice. Technology may be integrated at any or all
stages of treatment to help with stuttering or social anxiety,
incorporating clients, family members and other speech
pathologists. It has the potential to make treatment more