EFFECTIVENESS OF DIGITAL MANIPULATION OF THYROID CARTILAGE IN THE MANAGEMENT OF STUTTERING IN ADULTS

Nasir Khan, Tahir Masood, Waqar Ahmed Awan

Abstract


OBJECTIVE: To compared the effectiveness of digital manipulation of thyroid cartilage (DMT) with Fluency Shaping Therapy (FST) for the management of stuttering in adults.

METHODS: This randomized clinical trial was conducted in Speech-Therapy department of National Institute of Rehabilitation Medicine Islamabad. Twenty male adult patients were recruited in the current study through non-probability, convenience sampling. The participants were randomly allocated into two equal groups (n=10): DMT group & FST group.  Scale of rating severity of stuttering was used to assess the severity level at baseline and after the completion of 24 training sessions. Three vowel approaches with four sets of 5-repetition each were performed for each vowel in DMT group. Training in FST group comprised of speech techniques like easy onset, prolongation of speech, continuous phonation and light articulatory contact in reading and conversation in three speaking situations (speaking with therapist, reading aloud and free conversation).

RESULTS:

Mean age of the participants in DMT group was 21.4±2.2 years and FST group was 20.9±3.2 years. At baseline, there was no significant difference between DMT and FST groups regarding the severity of stuttering (5.3±0.94 vs. 5.6±0.96; p=0.492). As a result of 12 weeks of treatment, both groups demonstrated significant improvement (p<0.001). There was no significant difference between the groups after intervention (4.6±1.26 vs 3.8±0.91; p= 0.12).

CONCLUSION: Both DMT and FST techniques are equally effective in the management of stuttering in adults.  Further large scale studies on adults and children of both genders are needed to compare effectiveness of DMT and FST.

KEY WORDS

Stuttering (MeSH), Stammering (MeSH), Fluency shaping therapy (Non-MeSH), stuttering modifications therapy (Non-MeSH), Behavioral therapy (MeSH), Laryngeal manipulation (Non-MeSH). 


References


References

Parry WD. Understanding and controlling stuttering. New York, NY, US: National Stuttering Association. 2009.

Perez HR, Doig-Acuña C, Starrels JL. “Not unless it’s a life or death thing”: a qualitative study of the health care experiences of adults who stutter. J Gen Intern Med 2015 Nov 1;30(11):1639-44. doi: 10.1007/s11606-015-3302-x. Epub 2015 Apr 9.

Healey EC, Trautman LS, Susca M. Clinical applications of a multidimensional approach for the assessment and treatment of stuttering. Contemp Issues Commun Sci Disord 2004;31:40-8. [Cited on November 20, 2016]. Available from URL: https://pdfs.semanticscholar.org/8f49/7cfb969ad15b8e448f0f86eb2501aff0d153.pdf

Ratner NB. Evidence-based practice in stuttering: Some questions to consider. J Fluency Disord 2005 31; 30(3):163-88.

Max L, Guenther FH, Gracco VL, Ghosh SS, Wallace ME. Unstable or insufficiently activated internal models and feedback-biased motor control as sources of dysfluency: A theoretical model of stuttering. Contemp Issues Commun Sci Disord 2004;31(Spring):105-22.

Kazenski D, Guitar B, McCauley R, Falls W, Dutko LS. Stuttering severity and responses to social-communicative challenge in preschool-age children who stutter. Speech Lang Hear 2014 1;17(3):142-52.

Herder C, Howard C, Nye C, Vanryckeghem M. Effectiveness of behavioral stuttering treatment: A systematic review and meta-analysis. Contemp Issues Commun Sci Disord 2006;33:61-73.

Blood GW, Blood IM, Tellis G, Gabel R. Communication apprehension and self-perceived communication competence in adolescents who stutter. J Fluency Disord 2001 Nov 30;26(3):161-78.

Sommer M, Koch MA, Paulus W, Weiller C, Büchel C. Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet 2002 Aug 3;360(9330):380-3.

Blanchard EB, Jurish SE, Andrasik F, Epstein LH. The relationship between muscle discrimination ability and response to relaxation training in three kinds of headaches. Appl Psychophysiol Biofeedback 1981 Dec 1;6(4):537-45.

Neumann K, Preibisch C, Euler HA, von Gudenberg AW, Lanfermann H, Gall V, et al. Cortical plasticity associated with stuttering therapy. J fluency disord 2005 31;30(1):23-39.

De Nil LF, Kroll RM, Lafaille SJ, Houle S. A positron emission tomography study of short –and long-term treatment effects on functional brain activation in adults who stutter. J Fluency Disord 2003;28:357-79.

Maqbool M, Maqbool S. (Ed). Puberphoonia Mutional False to voice. Disorder of Voice. Chap 65. In: Textbook of ear, nose and throat disease. 10th edition, New Delhi: Jaypee Brothers Medical Publishers; 2003. P. 272-3.

Stemple JC, Hapner ER. Voice therapy: clinical case studies. Plural Publishing; 2014 May 16;1-10.

Watts CR. The Voice and Voice Therapy. J Med Speech Lang Pathol. 2005 Dec 1;13(4):241-3.

Khan MN, Noor R, Awan WA. The role of digital manipulation of larynx in management of stuttering; A case study. Int J Rehabil Sci 2015;4(2):56.

O’Brian S, Packman A, Onslow M, O’Brian N. Measurement of Stuttering in Adults Comparison of Stuttering-Rate and Severity-Scaling Methods. J Speech Lang Hear Res 2004 Oct 1;47(5):1081-7.

Brin MF, Stewart C, Blitzer A, Diamond B. Laryngeal botulinum toxin injections for disabling stuttering in adults. Neurology 1994 Dec 1;44(12):2262.

Giraud AL, Neumann K, Bachoud-Levi AC, von Gudenberg AW, Euler HA, Lanfermann H, Preibisch C. Severity of dysfluency correlates with basal ganglia activity in persistent developmental stuttering. Brain Lang 2008 Feb 29;104(2):190-9.

Mathieson L, Hirani SP, Epstein R, Baken RJ, Wood G, Rubin JS. Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia. J Voice. 2009 May;23(3):353-66.




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KMU INSTITUTE OF MEDICAL SCIENCES (KIMS), KOHAT, KHYBER PAKHTUNKHWA, PAKISTAN- 2012

 

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