Delayed Auditory Feedback Systems
Delayed Auditory Feedback
Recently, I have had the opportunity to work with a patient
that has neurogenic stuttering. We have attempted easy onset and using
continuous voicing to improve the dysfluency. We have seen some gains with both
of these therapy techniques and I plan to continue to utilize both of them but
this patient has a goal to be back to work in a relatively short period of
time. So, I decided to try a delayed auditory feedback (DAF) system with my
patient. We have seen great results! Now there are several approaches to
providing treatment for patients who stutter and this blog post is only
discussing one of them, delayed auditory feedback.
1. What is
delayed auditory feedback and how does it work? DAF is a device that takes
your voice and delays it by a set time. This set time can be predetermined by
the speech-language pathologist or the patient. DAF systems are thought to best help patients
who stutter that have an under activated auditory processing system.
Before I try this system with a
patient I explain to them it’s like you have a poor connection with your phone
and you keep hearing your voice echo. Instead of turning off the phone for a
better connection we are going to be working through the delay, the best way to
work through the delay is to slow your rate of speech and prolong syllable
sets.
DAF systems have come a long way. I
was first introduced to DAF systems with The Facilitator that, I believe, was
made by Kay Elemetrics and Dr. Daniel Boone. I don’t think they even make it
anymore but if you click on the link below you can find an article on The
Facilitator. http://www.kayelemetrics.com/index.php?option=com_publication&Itemid=5&id=16&menu_id=46&subid=194
Now DAF systems are available on
the VisiPitch (the system I have), apps, and various other forms. The constant
with all of the DAF systems is that there is a microphone for you to speak
into, a processor that alters your voice (in our case delays it) and an ear
piece for you to hear your own voice at the selected delayed time.
2.
Do we
have evidence to support the use? In graduate school I was taught that a
DAF system is like a one hit wonder, it only would work while the patient was
wearing the device, once the patient removed it that there would be no carry
over. I was pleasantly surprised when my colleague Kimberly Herrejon M.S.
CCC-SLP provided me with this journal article, Delayed auditory feedback in the
treatment of stuttering: clients as consumers. (Borsel, Reunes, and Bergh
2003). http://www.ncbi.nlm.nih.gov/pubmed/12745932.
In short, they first assessed patients stuttering occurrences independently and
with a DAF system. Over a three month time span they had the participants use
the DAF system alone, when they brought them back for testing they found that
the stuttering occurrences without a DAF declined significantly! So yes we do have some evidence out there to
support this method!
I
have also read that there is a method of using the DAF system in a weaning
manner. Some have started a DAF system at an appropriate delayed setting and
once their patient is fluent over several contexts they then reduce the delayed
setting and continue to do so until there is no need for the DAF system. I find
this so interesting and I can’t wait to find some more research on this!
3.
Is it for
everyone? I do not believe that a DAF system is a cure all for people who
stutter. I do think the best way to find out though is to give it a try. Your
patient will either have a reaction or no reaction. I had a patient in just the
other day that had no reaction to the DAF system despite several trials and
settings so we are not going to use it. We are going to move on and find what
works best for the patient.
4.
Video! This
gentleman did a great job presenting his DAF system. And I think it is a true picture of what a basic DAF system looks like. With some of the other systems they have made it much more discrete.
5.
Vendors.
I was so fortunate to already come across a pre-made list by The Stuttering
Foundation. It can be found below as well as a note from the foundation. I as
well have no financial ties to any of the below organizations.
“Note: The Stuttering Foundation of America does not warrant the
efficacy of these devices nor guarantee their treatment in any way. This page
is here for your information only. Appearing on this page is NOT an endorsement
by the Stuttering Foundation.
Speech Monitor
Rick Arenas
www.speechmonitor.org
SpeechEasy - $2,500 - $4,500
Janus Development Group, Inc.
112 Staton
Road
Greenville, NC 27834
252-551-9042
Toll-free (877) 4-Fluency
www.speecheasy.com
These devices, worn like traditional hearing aids, use altered
auditory feedback in the form of auditory delays & frequency shifts.
Casa Futura Technologies - $1,495 - $3,500
720 31st Street
Boulder, CO
80303
888-FLUENCY or 888-358-3629 or 303-417-9752
303-413-0853 (Fax)
www.casafuturatech.com
DAF, FAF, MAF, and stuttering bio feed back devices for
clinical, home practice, telephone, and pocket use. 15 States (CA, MA, TX, WI
and more) provide funding for anti-stuttering telephone devices to qualified consumers.
Schools may inquire about special rates.
KayPentax - $4,000
2 Bridgewater Lane
Lincoln Park, NJ
07035
800-289-5297 (toll-free USA & Canada)
973-628-6200
www.kayelemetrics.com
info@kaypentax.com”
The Stuttering Foundation has also
provided a list of apps and computer software available for DAF use. Again
below is also a note from The Stuttering Foundation.
“Note: The Stuttering Foundation does not warrant
the efficacy of these apps nor guarantee their treatment in any way. This page
is here for your information only. Appearing on this page is NOT an endorsement
by the Stuttering Foundation.
Apps for smart
phones, tablets and iPad/IPhones etc…
Software for Computers
I believe these are all already hyperlinked for
further exploring if you are interested! I also just wanted to take a short
moment and say a big Thank You to The Stuttering Foundation and other
organizations that support people who stutter. I am so impressed with their the
time and dedication!
6. Real life Experience. Here is a review from a person who stutters and has used a DAF system. Some of his thoughts are positive and some are negative but I think it is important to see both sides!
http://stutteringjack.com/speecheasy-delayed-auditory-feedback-stuttering-daf/
7. Resources
Have you used a DAF system before? What is your experience?
Very informative article. Looking forward to more posts in near future. I have also found some interesting info on
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