ACQ Vol 12 no 1 2010

Motor speech disorders

Weekly prolonged speech treatment for adults Wendy Lloyd, Margaret Webber, Mary Erian, and Stacey Sheedy

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. T he 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

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;

Keywords adult non-intensive prolonged speech

stuttering treatment

This article has been peer- reviewed

Wendy Lloyd

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ACQ Volume 12, Number 1 2010

www.speechpathologyaustralia.org.au