Electronic Fluency Aids

by Marty Jezer

Article from the ASHA SID4 newsletter (October 1999)

This article is about electronic devices for stuttering. Some call them "fluency aids." I prefer the term "anti-struggling" devices, because what they do is change the nature of my stuttering and, as a result, remove the burden of stuttered speech. Few people who stutter are familiar with them. Other than through self-help and internet discussion groups, there is no way for the manufacturers of these devices to advertise their existence. In the past, speech pathologists were hostile towards their use, but that hostility has diminished. While some professionals still oppose their use as a matter of principle (stutterers should not depend on a "crutch" for fluency), most professionals are simply unaware of their existence or, if they are aware, have never seen them used.

In addition to describing some of the devices, I will argue that electronic devices can play an important role in helping stutterers communicate more effectively. They can be put to good use in therapy programs, especially in transfer situations. And they can help young people overcome the traumatic experience of giving public presentations in school. These devices, I will argue, need to be taken more seriously by the professional community.

A brief personal note: I'm 58 and still, measurably, a severe stutterer. I've had every kind of therapy imaginable. I've been through the Hollins precision fluency shaping twice, the second-time for free because early on during my first three-week session, Dr. Ronald Webster, who heads the program, noted my difficulty achieving a proper gentle onset, even within the confines of the clinic. I've used electronic devices since 1984. I still stutter, but not as badly. I've become, thanks to the example and encouragement of members of Speak Easy and the National Stuttering Association (formerly National Stuttering Project)—as well as to the portable DAF and Edinburgh Masker devices I use when speaking—an effective public speaker, not only at self-help gatherings but in meetings of people who do not stutter.

The electronic devices I am familiar with are the Edinburgh Masker and those manufactured by Thomas David Kehoe of Casa Futura Technology. I have used the Masker for more than fifteen years. In the past year or so, I've been experimenting with the Casa Futura's devices. All are portable and battery-operated. Each consists of a small box-like unit that can be worn (and hidden) on a belt or in a pocket. Two wires (hidden under a shirt) attach to the unit. One goes to a dime-sized throat microphone that can be taped (with double-sided tape) to a point on the neck near the vocal chords (it can also be held tight to the spot with an elastic band). The second wire goes to inconspicuous earphones (there are a variety in use). When you speaks, you hear a particular noise (depending on the device) and this will aid your fluency.

The Edinburgh Masker produces white noise, a masking sound that drowns out the sound of your own voice. The noise stays on for a fraction of a second after you stop speaking. This allows you to move easily from one word to the next without the masking sound switching on and off. The Masker, which comes from the United Kingdom, is no longer being manufactured, but I've heard from the British Stammerers Association that production might be resumed.

Thomas David Kehoe, himself a person who stutters, manufactures three units. Two are portable. A pocket DAF (delayed auditory feedback) unit and a newer FAF (frequency-shifted auditory feedback) unit. Kehoe also manufacturers a desktop model for use with a telephone. Phone companies in some states will provide them free of charge to people who stutter. (For information, contact Casa Futura). The desktop models are also used in clinics. They contain components that enable clients to monitor their precision-shaping fluency targets. Many speech clinics use them. I used the desktop model for the telephone and will attest to its effectiveness. But my focus here is on the portable pocket models.

Electronic devices do not cure stuttering; no unit I know of produces perfect or automatic fluency. Each type of device seems to work differently for different people. And studies show different rates of improvement for different people. Some units have a carry-over effect, but not for everyone. There is, I believe, a general consensus that these devices will improve the speech—to a lesser or greater degree—for most everyone who uses them.

In my case, the more conscious I am of using speech techniques (for me, slowing down and using voluntary stuttering) the more success I have with the devices. Once I begin vocalization, my speech comes fairly easily. I still stumble on consonants but my speech moves forward. Speech is no longer an exhausting effort. I still stutter, but I speak effectively.

I don't have much faith in subjective self-reporting (especially my own) and wish that my speech could be studied with and without one of these devices. Empirically, I know that they have made a difference. Friends who I've not seen in a long time almost always comment on my improved speech. More to the point, I speak more, and in all situations. I always battled my fear of speech. To me, avoiding speech is worse than the actual spasms of stuttering. But sometimes speech was just too difficult—for me and my listeners. There were many times, before I used the Masker, that I wanted to speak but chose to keep silent.

Now I don't fear talking. Conversation is no longer an issue for me. I consider myself fluent, even though I am still stuttering. With the help of my devices, I've joined Toastmasters, and have come to delight in public speaking, not only at self-help conventions for people who stutter but for audiences of fluent people. A few days ago, I spoke up at my local school board meeting. It was a heated topic, there was a large audience, and it was being broadcast live on cable access TV. I stuttered, but I held the attention of the audience. Without my DAF unit, I wouldn't have done it. It wasn't the fear of stuttering in public that would have stopped me. It was my level of disfluency; without my portable DAF, the audience would not have understood me. And that, not the fact of my stuttering, would have been humiliating.

I am most comfortable with the Masker, because I've used it longest. The noise sometimes bothers me, as do the plastic (custom-shaped) earplugs. On hot days, my perspiration sometimes short-circuits the unit. (C'est la vie). The Casa Futura devices also have this problem, though the FAF and DAF sounds are much more easier to take than the white noise of the Masker.

The Masker (like the DAF) encourages monotonic speech. It wasn't difficult to overcome this drawback. I learned very quickly to make myself aware of inflection and speech dynamics. No one has ever called me a monotonous speaker.

Kehoe has suggested that the Masking sound, because of its harshness, adds tension to the vocal folds (taking away at least some of the advantage that the unit initially provides). I think he is right. The DAF and FAF seem to be much more relaxing, but again this is self-reporting. I would encourage a study that measures the effect of these devices on vocal folds tension.

The DAF is my unit of choice for public speaking. It slows my speech and seems to relax my speaking mechanism. I'll use it next week in a "humorous story" competition at my Toastmaster chapter. And I'll use it later at a writer's convention when I'm on a panel about "memoir writing." The problem with DAF is that it tends to pick-up background noise. Not only do you hear your own speech in a delayed sequence, but you hear what other people are saying with a similar delay. This makes conversation difficult. Kehoe's unit allows you to lower the sensitivity of the microphone pick-up. This does cut down background noise, but it also lowers the volume of the DAF. I know two users who do well with their pocket DAF in conversation. I'm still trying to find an effective balance.

Speaking with the FAF unit is like choral reading. You hear the sound of your own voice as you are speaking. It's possible to adjust the pitch, and I'm still trying to find the optimum setting. Sometimes it works well when the pitch is only slightly altered. Other times it works better when what I hear is the sound of my voice a half or full-octave lower. I've yet to try it at a higher-pitch. For me, the FAF is a work-in-progress. It does lessen my disfluency and diminish my facial and speaking tension. How much? I wish I were part of a study.

Many severe stutterers, who suffer from what Dr. Eugene Cooper calls "chronic perseverative syndrome" (CPS), could make use of these devices. These are stutterers who simply can't communicate. An electronic aid could ease their struggle and allow them to communicate—even with a residual stutter.

Ultimately, the choice is up to the individual stutterer. But I would like speech pathologists to present these units as an option, especially for their clients who are having trouble transferring their techniques into real-world situations.

These units could also be offered to moderate stutters as an aid to public speaking, job interviews, and all those high-stress situations where good communication is necessary. A little boost in fluency could help them in their careers, in their studies, and in their social and civic activities.

What about teens and children? I'd hate for children to become dependent on a device so much so that they'd give up speech therapy. On the other hand, these units, especially, the DAF device, can be an aid to therapy, helping the client to slow down and use techniques, even in difficult transfer situations.

There is nothing more devastating for a child who stutters than giving an oral presentation in class and not being able to get a fluent word out. For many kids, the humiliation they feel in class affects their self-esteem and their identity. Kids who are defeated by speech may have difficulty responding to therapy. The weight of defeat is simply too overwhelming. An electronic device is no substitute for a sympathetic counselor, but it might make speaking in class less traumatic. Speaking success in a classroom setting would, I am sure, have a positive affect on the way children who stutter feel about themselves. And this could have a useful carryover affect on their attitude towards therapy, and of helping themselves.

The Casa Futura devices and the Edinburgh Masker are not the only electronic aids on the market, but they are the ones I'm familiar with. My plea, again, is that specialists in stuttering look at these devices as useful adjuncts to formal therapy. And that researchers gather some data on their effectiveness in real-life transfer situation. Electronic devices may, indeed, be a "crutch." But some of us are, in fact, verbal "crips." People with hearing problems are encouraged to use hearing aids. Why, then, aren't people who stutter encouraged to use fluency aids?

Not all will choose to use them, but the choice should be ours.

Marty Jezer is the author of Stuttering: A Life Bound Up in Words (Basic Books, 1997). He was recently chosen "Member of the Year" by the National Stuttering Association.

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