INTRODUCTION TO SMOOTH SPEECH
Smooth speechis a cognitive-behaviouralapproachto the managementof
stuttering.The clientis taughtto mcdify thespeech to producefluent
process
speech(;.g., modifyingbreathirJ, reCucing rate).
Smooth speech is different
fiom othei"complex"speechmodilicationtechniques suchas prolonged speech;
however,bothofthesetechniques developed ftom a commonsouce.
In 1965,GoldiamondinYestigated the effectofdelayedauditoryfeedbackon
speakers.DAF causedpeoplewho stuttered to adoptan speech
unusual pattem
(slowing,prolongingsounds,monotone) in ana$emptto overcomethe effectsof
the auditorydelay.Goldiamond discovered thatthispattemcouldeliminate
stutteredspeechandcalledthe pattem"prolongedspeech"Prolongedspeech
hasformed the basisofmany ofthe fluency shapingtechniquesusedin the
treatmentof stuttering.
Also in the mid-1960s, GavinArdrews,a psychiatrist,
Professor began
researchingnew methodsin fluency treatment.He rurIprognmmeson an
intensivegroupbasisanddeveloped theconceptofusingspeech rate
modification(a.k.a.syllabletimedspeech).
In 1968,RogerIngram,a speech joinedGavin'steamat Prince
pathologist,
Henry Hospital, Sydneyandintroducedto theprogrammethe conceptsoftoken
economyandprolongedspeech.The programmewasconductedin a residential
intensivegroup settingover a tkee weekperiod.Prolongedspeechcontinued-to
developover t-henext aight yearsandmodificationsto the techniqueresultedin
the early smoothspeechPattem.
In 1976.the first thee weekintensivegtoupprcgrarnmewas conductedat the
Mater Hospital, Brisbane.The programmewasin strict accordancewith the
PrinceHenry model,but by this time, the token economyhadbeenreplacedwith
a systemofmonelaryrewardsard fininE
The Prince Henry Programme,undel the directionof GavinAndrews,relocated
to St.Vincent'silospiial in 1986.Theprogramme in
was,however,discontinued
1994due to cosfcutting. The proglammeat the Mater Hospitalcontinueto
follow the basicprinciplesof the PrinceHenry model.However,major changes
havebeenmadein the servicedelivery andthempeuticcontentofthe
programme.The overall treatmentprogrammeis divided into four phases:
r PRE-COI'RSE THERAPY (smoothspeechis taughtindividually)
* INSTATEMENTof fluencywithin theclinicthroughmasspractise
* TRANSFER of fluency outsidethe climc
* MAINTENANCE of fluency following transferphase
The smoothspee.ch programmeconsistsofa seriesof €ight strategies.These
stategios teachthe client how to re-Fogrammethe speechmechadsmin order
to producefluelt speech.Speechis the mostcomplexactthat rveperform in
terrnsofthe cognitiveandphysicalprocesses that mustbe a.tivated.Any
strategywhich simplifi€s this complexprocesswill ultimately enhancefluency.
I. RELAXATION
In older to apply atl otherstmtegies,the personwho stuttersmust be ableto
conhol anxiety andbe asrelaxedaspossible.By understandingandexperiencing
generalbody relaxatio4 the client is ableto leam to transferthosemonitoring
skills to the difficult task ofmonitoring the speechmechanism.
2. THE MECHANICSOFSMOOTHSPEECH
* Br€athing - a slow controlledinbreathandslow smoothchangeoverto
outbroath
* Gentle onsets/slow smoothtrunsitionsinto phrases
* Gentle contactsby the articulators
* Continuoussmoothmovementofthg articulators
* Continuousairflow
* Normal intonation,stess pattemsandvoice quality
3. PLANNING
Clients are taughtto deliberatelyuseshortphrasesso that informationis
deliveredin syntacticallycorreot'thunks". Shorterpbrasesareeasierto
articulat€and aremorepredictablein length,thusplacing lessdemandon
respiratorycontrol. The <phrase.pause'tecbniqueteachesthe client to usea
longer pausetime betweenphrasesto allow tim€for lhe monitorilg ofa rclaxed
inbreathand to facilitatebetterthoughtplanning.
4. RATE CONTROL
Slower speechratesplacelessarticulatory,respiratoryandlanguageprocessing
demandson the speechact.The client needsto masterboth control and
monitoring ofthefu speechrate,Slotv sp€echratesarc taughtfiIst. The ability to
be able to slow speechdown in stressfulsituationsis alsoimportant.
5. ATTITUDE CIIANGE
Anxiety control andcognitiverestructudngstmtegiesaxetaxgeted.
6. REHEARSAL
Rehearsalinvolvespractiseof fluency enhancingstrategiesandpractisingvaried
speechtasksin real life situations.This is especiallyimponantduring '1ransfer".
7. HIGH LEVEL COMMUNICATIONSKILLS
Skills suchasassertio[ andnegotiationareusuallytaughtin the goup setting.
8. CONSIDERATION OF ENVIRONMENTAL FACTORS
Modifications within the speakenenvilonmentmay be necessary.Self-
expectationsand expectationsofothers may needconsideration.
A Fromeworkfor TeochingSmooth Speech(plusotherbirs.l
Smoolh Soeech Stroteoies Other 1if indicdted
1, aenerolreloxotion . Rqte Control
I0-15ninutes
petsession
(unless it is the mainfod$ af
2. Breothing- rheory
- smoolh speech
- pr?€tice . OnceSSbr€athins
under
larEo!-
Sttategic SS br@rhihg+ ruiworde+
Iehgrheifiml (srressed)syllobl€.
* set pluases/bioinfo
i. Voicing - theory * marked rcading passages . VoiceThe.opy
- smoothspeech + tmnsitionalactivities
- przcr'ce
5'10 hinutes per session
. Onceabovestl-aregyis
4. Arficulotory Contocts I €ffectiveat r€ducingstuttering . ArticulotionTheropy
- rheory i during tmnsitionalactivitiesi
- smoothspe€ch I bEsLocKrNG
Breothealloir Out -2 -3 ondrelox
B r€qtheln-2-3
Genllyeds€inlo first word
5- Putting if oll togefher.--
. Brcathing/Counting
. (itrdphr.sing)
Sentences
. paragaph . SpecificHelpfo.
. ReadinC FluencyDilelnhos...
. Transirion I I
t aashan2oes I l. retephone
s.rup1^-bhoo.,t4.l
. |. - l. oralpresenrarions
Conv€$ation Begin fonnalcogniriv" ]- Intro;uctions
resrrucluring
al I50 spmtevet | , Difiicutr*oros
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you flueDc/ Roteploy
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I i":ilt'#; Record...
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E.A.CARDELL
- SPCH2103 FluencyLectures2OO3
SMOOTHSPEECHTREATIITENT
FORMATS
* Pre-courseindividual
+ Pre-intensivemaintenance
* Intensivegroup programme- non-residential
- residential
+ Post-intensivemaintenance
* Post-intensive
individual
* Boosterprograrnmes
NEW!!! r Self-teachingfrom video/audiotape- individual or (short)group
Programme
INTENSIVE PROGRAMMES
l. Instatement: masspractice50-100-150-200 spm(Day l-2)
: after this, eachday startswith rating sessions(5 mins per rate)
2. Trawfer : assignments
50-100-150-200
- home -within clinic - outsideclinic
3. Daily relaxation sessions
4. Daily teaching sessions) introductions- rcquests- phone
- specialtopics: rationalthinking/positiveaffirmations;maintenanceof fluency
- video (l min talk at goal rate)
5. Daily self-assessment
- home(fluency tally sheet)
6. Rate control activities
ASSIGI\MENTS (5 mins) (Often, role-playedfirst...)
Home conversations- Introductions- Phonecalls: friends,strangers- Requests-
Conversationsto strangers- 2 minute talk to a groupofstrangers
SMOOTHSPEECHPROGRAMME
LA TROBEINTENSIVE
Block et al., 2005
'10-15participants
with equalnumbersof students
. IntensivePhase= 5 daysfor t hoursper day
. MaintenancePhase= Onceweeklyfollow-upsessionsfor 2 hours per
weekfor 7 weeks
. 2 offeredpersemester
Reviewdays=Thours;
INTENSIVE:
. Days l-3 = Instatement
= learningsmoothspeech@ 60 ) 120,
(increments)
thenupperrateof 200spm
o Key concepts/rules taught(e.9.,easyonsets,linking,
explicitly
elongating
vowels)
o Clinician is primaryteaching
modelling method
provided
o Audioexemplar
o Startswith singlevowels) words(VC , CVC)) multisyllabic
words ) phrases) sentences) reading) conversationto
instate60 spm.
feedbackto clientabouttargetsevery15
o At 60 spm,clinicians
seconos
o At 120spm+, is givenevery1-2minutes
thisfeedback
o At rates of 120 and above, encouragedto use speech that
sounds'asnaturalas possible',whilstusingsmoothspeechto
remainstutterfree.
. Days4-5 = Transfer= assignments.
o Preparesindividualhierarchyof speechsituations(6-20)
o In theworld+++
MAINTENANCE:
2 hoursessions
o lvleasures
of %SSin-clinic
o Reviewof homepracticeactivities
o Reviewof smoothspeechtechniques
aroundgeneralization
o Problem-solving issues
andmaintenance
o Last% hour= groupinteraction
andpractise.
REVEWDAYS:7 hours.Unlimitedaccessto these
Stuttering
Outcomesare favourablycomparableto the Comprehensive
Programme(1985:Canada),and to the CamperdownProgramme(2003:
andSmoothSpeech(Craiget al., 1997).
Australia)
PR"tda.6ent rnmeli.tat 3 osaiis |.,! 1? r6it:
posl lntefrsive i^ren ve ,.rt
'nla]'sl,c
perse in the programme.
Note,no cognitiverestructuring
('f995)well knowncriteriafor evaluatinga treatmentis, 'themethod
Bloodstein's
must be shown to be etrectivein the hands of essenliallyany qualifiedclintcian,
includingthose withoutunusualstatus,prestoe, or force of personality'(p. 445\.
Clearly, qualityas such.
studentclinicians
PROLONGEDSPEECH
TREATMENTF,RMAT*:havebeenmoreexclusivethansmoothspeechformatsinthepast..'
* Residential * lntensive
' lndividual
Phases:
Ins(atemellt- 6 progressive speech
stag€sto replacestunered
- rarsets:continuous vocllllzauon
sofi contacts
gentleonsets
- taught by cliniciansassistedby taperecordings
or conversation)
(monologue
- taughtvia ratingsessions
100spln(700'yl)
r
I StaseProslession " 70spln(500syl)"+
40 spm(300syllables)
* each(rate) stagehas6 st€ps.Failwe (i.e., rate or stuttering)at a later stepmeatur€gressionto the
stage'
firsl step;failre at any stagemeals regressionto the previous
II NqturalkessStaseProQression:
-
= natual)
Soeechnaturalnessmeasuedon a 9 point scale(1 highly
Ciinician scoresnatualndssandfeedsbackto client evcry mrnute'
whateverlate they wish' gndexaggerate
No speechrate feedbackgiven, so clients rnayspeakat of
i.l#." .i"t"f""-.a spelh, providing they remainstutter-freeandmaintain.atargetlevel
;;"il;i;;-i 0o ratinsof2 over 3 stases)
fN.e.co;l = nsnnalness
"vrr"urio 'he
Tralsfer : within-clinicandbeyond-clinic assigrunents
-skrtt"ring ot u-atural speech- failwe!
Self-evaluationis a clitical featue
Maitrtetrance: self-
withlessfrequent
theclientis rewalded
aremaintaine.d,
ffiEffii"quir"ments
aod clinic visits.
assessment
No. of weeks 1,1,2,2'4,4,8,8,16,16'32,32 (2'4 veus\)
Failwe at any stepmeansa retutl to the fi$t step'
prior to eachstep(and self-evaluated- clincian
6 beyond-clinicrecordingsaremadein the week
randomlychecksthat tapeshavebeenevaluatedconectly)
tasksmustalsobepassed
6 within-clinicl3oo-syllablesPeaking
CAIPERDOII'I{ PROGRAI'X€IREATI'EI{' TTANUAL
The progrgmmehas th6 follo ring 3alienttcatur6:
t. Tho trcatmcntt6chniqu€u!.d b Prglonlad Spoc.fi (PS).
2. The proo€mme b b$6d on individueldinic tcssions apsrt from on6 group praciicedsy involving2-3
clicfttl and 2-3 diniclens.
3. PS b taugl wilhoul rcfcflnce lo lraditjonaldrlcilption3 of 3paadl tieoatr luch a6 "g€rilr omets, end
'sofi cont cls.' lffiio.d, dirnt! Lam the t€chnquo by wel.iing and imiiatinga st ndard PS vid€o,
accomp€njtdby wrilton lext, Th6 videodgmonstratgsPS in a slow €nd cxegg6retodmannerin
connactcd3pa€ch.
4. Inslelooant of 3lultea-frcespeochinvolv€sno progEmmedinstruclion,3po€chrst€laeollt or
naturaln6!3tqr9sts.
5. Cll€nll aro frce lo individualbelh6ir PS patt€m.Th.y 6re encoureg€dto us6 whatev* toaturesof Pg
they llquill to contol th6ir stutterino.
6. Th6 progremmaconlaiB no lfuclur€d or hiorE(tricalirao3farphasc,
7. A Spoint taverity r8tingac€lonaplecesinsbumenlalionfor gfutt€roountmea3ur6swithin end beyond
dinic.
8. A gpoinl nalurdln63sscele is usod by clinician! lo evsluste9p€echnalurelness.
L Self-.veluationfof subsoquentp|oblem-3olvingis introduc€dfrom the lilst s€$ion.
10. The cli€ri rDquirasaaces3io a practic€partnarfor spo€chpaacticeon e daily b€sis.
The Progmmmoha3 loff compon€nb: lndMdual T66d\ing S€ssions, a Group Practioe Dey, Individual
ProblemSolvingS€s3ion3and e MEinl€nencePhasa,
Indlvld.r.l Terching t. akrn.
A0:
To delemine if di€n$ can l€am lhe basic behaviour! (productionof PS end evetu.tion of stuflering
gevedv) ruquimddudngth€ltgatm€nl.
Mdied:
Theaaar6 4 6lag€s.TherEb no formalconrl€tion botw€€nstag€s and numberof ra!!ioo3. lt iBpossible
for 2 slegos to be achievedwithin on6 3o3sionor sltomstivcv on€stagc c€n rrquirDmolr then on6
glqscl
SEVERITY RATINGS
1, Bas6lin€:diniden r6cords5 min convo€€tion.
2. Oinician introducasgpoir sovedt raling scele(SE\4.
I = no slutledng,I = extromet sev.rc Btultedno(vid€oexemplaB,if requircd).
3- Clieri .3!ign3 SEVscor6 lo WC bas.line, accordinglo ebov6scele.
4- Clinicianaod cljent disct|3! r3ting.
5. Client lislonsio sagmonlgot hB pr6-lreatm6nltiep€sand assignsSEV retingsto lhes€semple3.
PROLONGED SPEECH
1. Cliontwatchs a video exomplsrof PS domonslralodin a slow and exaggeraledmennorin connected
3poeci. This is eccompaniedby written text. H6 altemptsto produc€e similerpsttem by imitetionand
readingin unBon,
2. Cliniciangivesfecdbackabout PSwilhout .eforoncoto the sp€cfic taeots of 'sofr coflt cl3,' 'gcr{te
oB€tg,' 'conlinuousvocslbation,' or ary olhlr targcl, Fc€dbackghoulddiroct client bgck to th6
domoNlreljon videoto lry lo copyexomplarmor6clogey- Oinician can b€ak pEslaga inio smaller
uni8 for feedbackif nccassary.
3. Clientlo eltablilh precticepsrtnorfor futulo daiv sp€€chprectic..
I|oME ASSIGNMENTS (HA):
HA'l: Clialnto grephdeiv SEV retin$.
l-lA2:Cliontio t8p. rbcord!.wral 1-2minutaconversaliomb€yondtho dinic (no petl,.m lo bc usod)
and essjgnSEV ralings.
HA3:The cllentis given an eudiotap€copy of th€vidooex6mplarand B inlLucl6d lo
- li3t€nlo th. qomplardaily.
- pre.lF€ laadinglho p3$€9. with end withoutlhe ox€mplaretlsmpiingto m.tch th€lteining
lape 33 do3dy a3 possibl€.
- recod liva rordinos of lha pa$ag. ovor 3everald.y3 .ti.mpfn€ lo metchthe t ainingtap€a3
clo3alyas po3!ibl6.
gc&2
SEVERITY RATINGS
1. Basalino:Clinicianr€cords5 min convoG€ijon(no iBlruclion to |tse p€ltam lo be givcn),
2. Cli€nl lElos SEVol the sampl€-Clienl and dinician comp.ro and discussraling of sampl6.
3. Clinidan listaru io HA2$signm.nts and dilqrssos dients sEV ralinF tor lh€se 3ampl63.
4- Clinicianr6cod3 and discus36sdienl's gEph€d BC SEV retlrgl3.
PROLONGED SPEECH
1- Clinidan disqrss€s HA3r€cordingsin lerms of whctherlh6 PSwas ecceplable.Furlhertrainingif
r6quired.
2. Clientatlemptsa 1-minulemonologuewing PS p€ltomsimilerto trainingvideo.
3. Cliantavaluale! paltcm and diniqsn paovkl6sfu€dbackon 1-minmonologua,
HOMEASSIGNMEI'ITSfl"I,A):
l-tA4:Cli€nl !o g.aph daiy SEV relings.
HA5:Cliont lo lape rbcords€vefil 1-2 minuteconv6'3aliorubcyondlhe clinic and a'3iCn SEV ralings.
HA6:girrnl lo pr.clis6 PS daily,bolh rvilh the audio recoding ind in l-minule monologu.s,u3ingeudio
oxomplariapa e3 model.Cllenl io evalu€tehis own pedomanco.Clicit to tape rscotd live l-minute
mondogu€ usino PS eppoximafinglhe oxomplar.
S!a!9-3
SEVERIWRATINGS
1. Basalina:Clinicianrocor& 5 mrnconvoBation(no ilstrucrion lo u3€pellem to be giwn).
2. clianl ret€s sEV of the sampl€.Cliontand dinician companaand dilc1rsaratingot sample-
3, cliniden lbt6n3 to HAs a3*Dm€nt! and dbsls!€s dionfs SEV retingsfor lh€36 sampl.3.
4. Oinician recordsand di3dJss€sdienl's grephodBC SEV retings.
PROLONGEDSPEECH
1. Cliniciendiscurses HAOrecodings in terms of whelhorlh€ PS uds eccaptebl€.Furthortrainingif
r€quar€d,
2. Clienl ettemplsa 3 minutomonologuor8ing PS pattcm,
3. Clientovaluet6 pafi€m and dinician providostccdbackon 3 minutomonologue.
cEs4
1. Clinicianexdoins proc€durcfor 'T pha3€' on GroupPrectic€Day.
2. Oinicien fecilitatc! productionofsiuller-trea PS .t vadousmturdna$ levols uling lh€tollowing
instruclion:
" I want you lo oxperimentno* with th6 PS techniquothat you havo l€6m1. L,9awhalovorfaalurls of
lhc lrchniqu6 you needto 6nain in controlof yourltult r. w}lilc rcmaining3lult6Ffrlc, 3tc if you can
mekoyour sp€ochsoundmoreecc€ptablo.'
Thb willng! bo 3pc<ificallyr.l€tod lo MT l.y€ls-
3. Cliantand clinici.n €veluetoSEVand e.c.plebility of spo€chpstlam.
No_a$i{|nftor s tollo* 3lrg€ 4, howrvor thc dient b expadod to prsdi3€pS daily with pra<ticepanner
unlil enlaringGloup Pr€clic6Oey.
A metimum of 5 sealion9 b Elloa/adin *,itl*r lo sdtieva steges i-{,
'Crilode'for movingioto croup Fte.tica Oay.
Client mu3t b€able lo:
- Us€PS that epproximatcathr $d6o exafiplar to conkot shrt|cring.
- DcmoBhate ebilityto vary the afiount.nd th. wry thc pS pett€; is ur.ct whit€r€maining
3tutter-tlj.a,
Group Pr.ctca Day
A!!I)g:
1. For clionL lo gainconsistentco|ltlol ovorth€ir stuttodngu3inge naluhl soundingspe€dl patlem.
2, For cliant! to practis€salf-evaluationof stullcdng 3€vorityand amount of pS pattcm used.
3. For dient to dovelopproSldn solvingskitb (bstancab.tw€en controtof stuttlring snd natuEt Bounding
3poech)to essBt gen€ralbelionof stuttoFltla specch.
Uslhglt
A group of lhr6o di€nb attend3frcfi approximstov8.0OAM to 5.30 pM. Ouringlh€day, dient! totato
lhfough 14 cyclss. Eachcyclo consi{r of thl!€ ph8ca. Therc ar€lv/o.peakina phasei, nemodpladice
(P), Trial (r) and one Evalr|ation(E) phas6.
The F+13€ con3i3t3of dinidan-eup€M3ed sctice usingoxagg€|atadpS (with and withoui iha €xemptar
tape)whilo talking in monotogu€.F€€dbackaegivenin lh6 s€me m.nn6r es when te€chingth€pa em in
the IndivktualTeachingScalions.
The T Pha!. consbl3 of clinician-rupaNis€dspoekingin monotoguo,with tt). clicfit in3truatodto us!
trtl€lovar fealur.3 of the PS pattcm th.l ar€n €d€d io controtstuttering.Dodngthis pha!. th6 di.nt is
an3lrulledto €ltompt to achievethr6€goab: (1) io maintrin a SEV rEtingof 1 - 2; (2) to 3ounde3 hoturstas
possiHr; and (3) to mat rt on-linesclf-6vatuationot SEV reting3to thos€of thc diniclan. The triat i9 tep+.
rlcofthd by lh€client.
At tha end of oach T Phalr, the diniddn rrco.$ a SEV and NATscor€on a dat co .ction graph.The
dient l6cod9 a SEV scor€ony sltho{rghh6 may be alked to comm€{rton ho/v much pS he waa U3ingend
how eccapiablehb 3p66dt pEtlcmsoundod. tf gEV b >2, the dj6nt E requir€d!o lrtum to a p ohas€
dunnoftc ncxt speakinophase.Th€clinicianend cttenttogothcr\Nortout e 3tratcgyior th€nen cyctc.
Th. Ejhg!! B en opportunilyfor tho diar[ lo tbtcn to tho lecordingsof hb p|rvio(,s ttvo spe€tjno phE3.3,
to G,ovaluete stult dng lev.dt of-tino, io corddcr thc acc€ptebilityof th6 !p.€dt pattrm duing thet
ph$a, end lo dccid3 on a 3trat.gy tor usi.g Ps in the nod phase.
For the ,irst six ot th4e P-T-Ecycles,phas$ alo o€clt 5 mirutca long. The p and T phe36s.r9 conducted
individualv rvilh a clinid8n end th€E ph336occurs ind.p.nd€ntly. Foi the rlmr$ning I cyct.s, the p and E
pha!.3 Fmain 5 minutos long, hlt e 2Gminute group conv€rsaiionrrplacas thc Gdividuat T phas6
monologuowilh lhe dinician. Thc thr€a goati tor th. group lossions rcinain idonticst to tho!6 of th€
indiviclualT phes6. Eadt cliont b peir€dwith a clinici.n for th6 p end E phes.3. In tha p phas€, diants
pladilc PS and abo plan 3tretegio! tor uling PS in th€group. In th6 E pha36, th. cti.nt .vetuet63 and
cli3cuss€!with lho dini{:ian,his lpoodt in lh€Lst grcup s6$bn ard plan3e strat€gyior thc next cycle_
Tho programm6corneinsno hiereftrlicsl progrcasionthroughihe day, ho*ovcr, tho fottowingguidelines
apprylo the sp€akjngph$6s:
1. Th6 Practis€pha!. is ahfray!iottowld by a Triatphele.
2. A Tnel phas€of SEV 1-2, lerdi to . choic6of s 3ubs€qucntPrectic€or Trial Dha3€.
3. A Trisl phaseof SEV >2, i! ei|aF follo\rrd by e Pr.ctt36 phss€.
4. Ev€ry3E cycl€b€in3 with a Prectic. pha!€.
5. Affcr 6 cycl€3,if lh€clionl i! congist€ntt producingsp€€di at NAT6 or glletor, lhe g'point MT scate
will be inlrcduc€dend mov€ricnt towads nol6 naturatsounding3pocafiwill ba facilitated.
ln lhe an.moon, e 9point 'ProlongGdSpc.dt. ratino5c€t. b introduc€dto th. cli.r : '1'=,'no pS " and "9"
= 'conJslar and extgglrEtcd PS ' _ This provid€sthe cli€ntwilh a marn3 ot mo€slrdngand doormanting
