Monday, February 05, 2018

A new treatment method for adult stuttering?

The well-known Brain science journal has a paper by the Watkins research team in Oxford, where they claim: "transcranial direct current stimulation combined with behavioural fluency intervention can improve fluency in adults who stutter. Transcranial direct current stimulation thereby offers a potentially useful adjunct to future speech therapy interventions for this population, for whom fluency therapy outcomes are currently limited."

ABSTRACT: Chesters J, Möttönen R, Watkins KE

Stuttering is a neurodevelopmental condition affecting 5% of children, and persisting in 1% of adults. Promoting lasting fluency improvement in adults who stutter is a particular challenge. Novel interventions to improve outcomes are of value, therefore. Previous work in patients with acquired motor and language disorders reported enhanced benefits of behavioural therapies when paired with transcranial direct current stimulation. Here, we report the results of the first trial investigating whether transcranial direct current stimulation can improve speech fluency in adults who stutter. We predicted that applying anodal stimulation to the left inferior frontal cortex during speech production with temporary fluency inducers would result in longer-lasting fluency improvements. Thirty male adults who stutter completed a randomized, double-blind, controlled trial of anodal transcranial direct current stimulation over left inferior frontal cortex. Fifteen participants received 20 min of 1-mA stimulation on five consecutive days while speech fluency was temporarily induced using choral and metronome-timed speech. The other 15 participants received the same speech fluency intervention with sham stimulation. Speech fluency during reading and conversation was assessed at baseline, before and after the stimulation on each day of the 5-day intervention, and at 1 and 6 weeks after the end of the intervention. Anodal stimulation combined with speech fluency training significantly reduced the percentage of disfluent speech measured 1 week after the intervention compared with fluency intervention alone. At 6 weeks after the intervention, this improvement was maintained during reading but not during conversation. Outcome scores at both post-intervention time points on a clinical assessment tool (the Stuttering Severity Instrument, version 4) also showed significant improvement in the group receiving transcranial direct current stimulation compared with the sham group, in whom fluency was unchanged from baseline. We conclude that transcranial direct current stimulation combined with behavioural fluency intervention can improve fluency in adults who stutter. Transcranial direct current stimulation thereby offers a potentially useful adjunct to future speech therapy interventions for this population, for whom fluency therapy outcomes are currently limited.

4 comments:

Anonymous said...

as i am a shuddering electrician this sounds painful. but did wonder would a little shock treatment help. lol

Anonymous said...

What I like about this study is it’s an exploratory approach to stuttering treatment that takes a very short time and no practice, without medical aids. In that sense it is similar to how some pharmaceuticals may help reduce stuttering severity, by increasing automaticity of speech. The study has some good methods: double-blind, use of severe PWS to avoid the problems of the variability of stuttering, a control group with sham direct current, and their appear to be no conflicts of interest. On the other hand, we have a small sample size, and we need to look at effect sizes rather then statistical significance. It may not be applicable to mild PWS, and took no accounts of possible sub-types, a second control group of severe PWS who received no sham or any treatment would have been been useful, and a third control group who received electrical stimulation with nothing else, etc...
The fact that the PWS did not improve on QOL Meauress is to be expected, since the time span was to short to measure this, and severe PWS, even when stuttering less still stutter a whole lot so the stigma is greater.

Anonymous said...

The typical stuttering treatment efficacy study is performed by the same therapist who administers the treatment. They seldom have the concept of conflict of interest because they think hey are wonderful human beings. They exclude PWS for arbitrary reasons (co-morbidities which they just intuit, ad hoc character-determinations). They p-hack, don’t have control groups, They don’t take into account previous contamination by other speech therapies, “long term” is at most one year, they seldom mention replication nor want to replicate other studies, and it is suspicious that negative results are not reported.
Here we have a study which is good because it does not claim to be a treatment, does not count on the ambiguous measure of how hard the PWS tried because no one was instructed to use any speech tool. So good on the researchers, even if the results are ambiguous.

Anonymous said...

I want to expand on the “trying hard” idea in speech therapy. It’s a huge theme in stuttering conferences where celebrities get up and wax eloquent about how severe there stuttering was, how hard they worked, and look at me now. What I like about this approach is that it promises benefits without work, onerous self-monitoring: the PWS is not blamed for not improving. In Behavioural approaches that is the go-to reason why the approach didn’t work is the vague verbiage of they didn’t practice. As an analogy: The speecheasy device may not work, or work only short-term, but no one ever blamed that on the PWS, they blame the speecheasy.