ACQ Vol 12 no 1 2010

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).

30

25

20

15

SS %

10

5

0

End of maintenance

End of treatment

Beginning of treatment

0.1 1.9 3.8 0.8 0

1.6 2.0 0.6 0.7 0

2.4 6.9

C1 C2 C3 C4 C5

26.4 24.6 0.6

Figure 1. WC %SS for all clients

10 9 8 7 6 5 4 3 2 1 Severity Rating

End of maintenance

End of treatment

Beginning of treatment

1.6 2.0 3.0 3.3 1.1

2.0 2.3 2.8 3.2 1.3

3.7 6.8 8.7 8.0 3.7

C1 C2 C3 C4 C5

* SRs were averaged for the week prior to the corresponding clinic visit

Figure 2: BC SRs*

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ACQ Volume 12, Number 1 2010

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